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(Circulation. 2000;102:2553.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Metoprolol-Induced Changes in Myocardial ¹²³I-Metaiodobenzylguanidine Uptake in Parkinson’s Disease

Paul A. R. de Milliano, MD; Berthe L. F. van Eck-Smit, MD, PhD; Andre C. de Groot, MD; Kong I. Lie, MD, PhD

From the Departments of Cardiology and Nuclear Medicine, Academic Medical Center Amsterdam and Ziekenhuis Hilversum, Hilversum, Netherlands.

Correspondence to Paul de Milliano, MD, Department of Cardiology, Ziekenhuis Hilversum, PO Box 10016, 1201 DA Hilversum, The Netherlands. E-mail pardemilliano{at}wxs.nl

A 58-year-old man who had had Parkinson’s disease for many years was referred to the Department of Cardiology because of progressive and severe symptoms of orthostatic hypotension. Examination revealed a drop in systolic blood pressure on standing of 25 mm Hg. Heart rate at rest was 84 bpm, and it increased to 88 bpm on standing. Cardiac examination showed no abnormalities. 2D echocardiography was normal except for a slightly decreased ejection fraction (48%, Simpson’s rule). The patient was treated with metoprolol, with a gradual increase in dose to 200 mg/d. After 6 months of treatment, symptoms of orthostatic hypotension completely disappeared. On examination, no drop in blood pressure was observed. Before and after 6 months of treatment, single photon emission CT (SPECT) ¹²³I-metaiodobenzylguanidine (MIBG) scintigraphy of the heart was performed. At baseline, almost no myocardial MIBG uptake was observed, as displayed in Figure 1, showing short-axis reconstructions of ¹²³I-MIBG SPECT acquisitions. After treatment, a dramatic increase in MIBG uptake can be seen (Figure 2, showing the same reconstruction as Figure 1), indicating restoration of functional nerve endings in the myocardium with metoprolol.

View larger version (26K): [in this window] [in a new window]   Figure 1. Figure 1. Short-axis reconstructions of cardiac 123I-MIBG SPECT acquisitions before treatment with metoprolol in a patient with Parkinson’s disease.

View larger version (29K): [in this window] [in a new window]   Figure 2. Figure 2. Short-axis reconstructions of cardiac 123I-MIBG SPECT acquisitions after 6 months of treatment with metoprolol in the same patient as in Figure 1.

Patients with Parkinson’s disease frequently exhibit symptoms of autonomic failure that suggest derangements of the sympathetic and/or parasympathetic nervous system.

Parkinson’s patients with sympathetic neurocirculatory failure have a loss of cardiac norepinephrine spillover and absence of myocardial 6-[¹⁸F]fluorodopamine–derived radioactivity.¹ In early and late stages of Parkinson’s disease, a decreased uptake of ¹²³I-MIBG has been described.^{2 3 4} MIBG is a structural analogue of norepinephrine and follows the same metabolic pathways as norepinephrine. A decreased myocardial uptake of ¹²³I-MIBG indicates a loss of functional myocardial nerve endings.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

References

1. Goldstein DS, Holmes C, Cannon RO III, et al. Sympathetic cardioneuropathy in dysautonomias. N Engl J Med. 1997;336:696–702.[Abstract/Free Full Text]
   
2. Satoh A, Serita T, Seto M, et al. Loss of ¹²³I-MIBG uptake by the heart in Parkinson’s disease: assessment of cardiac sympathetic denervation and diagnostic value. J Nucl Med. 1999;40:371–375.[Abstract/Free Full Text]
   
3. Iwasa K, Nakajima K, Yoshikawa H, et al. Decreased myocardial ¹²³I-MIBG uptake in Parkinson’s disease. Acta Neurol Scand. 1998;97:303–306.[Medline] [Order article via Infotrieve]
   
4. Braune S, Reinhardt M, Bathmann J, et al. Impaired cardiac uptake of meta ¹²³I- iodobenzylguanidine in Parkinson’s disease with autonomic failure. Acta Neurol Scand. 1998;97:307–314.[Medline] [Order article via Infotrieve]
   

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by de Milliano, P. A. R. Articles by Lie, K. I. Search for Related Content PubMed PubMed Citation Articles by de Milliano, P. A. R. Articles by Lie, K. I. Related Collections Autonomic, reflex, and neurohumoral control of circulation Cardiovascular Pharmacology Nuclear cardiology and PET