Alteración precoz de la función adrenérgica cardíaca en los parkinsonismos con cuerpos de Lewy / Early alteration of adrenergic cardiac function in parkinsonisms with Lewy bodies

Introducción: La gammagrafía miocárdica con 123I-metayodobencilguanidina (123I-MIBG) se emplea para obtener información acerca de la función simpática cardíaca, tanto en cardiopatías como en otras patologías donde existe alteración del sistema nervioso autónomo. En este estudio se analizan las características de la captación miocárdica de 123I-MIBG en la enfermedad de Parkinson (EP), y su posible utilidad para diferenciarla de la enfermedad por cuerpos de Lewy (ECL). Material y métodos: 108 sujetos fueron estudiados, 70 pacientes con EP, 21 con ECL, y 17 sujetos controles. Los parámetros clínicos evaluados fueron la severidad del proceso mediante escala de Hoehn y Yahr, las manifestaciones vegetativas, el tiempo de evolución y el uso de fármacos. La captación miocárdica se analizó tras administración i.v. de 111 MBq de 123I-MIBG, en imágenes planares de tórax a los 15 min y a las 4 h, obteniéndose mediante índices corazón-mediastino (ICM) evaluación cualitativa y semicuantitativa de la misma. Resultados: Los ICM obtenidos en los pacientes con EP y ECL, están significativamente disminuidos en relación con los sujetos controles (p < 0,05), siendo independientes del tiempo de evolución, severidad del proceso, uso de medicación o de la existencia de manifestaciones vegetativas. Los ICM obtenidos en los pacientes de ECL, se encuentran menos disminuidos que en la EP. Conclusión: La gammagrafía de inervación miocárdica con 123I-MIBG detecta tanto en los pacientes con EP como en los de ECL alteraciones de la función simpática cardíaca de una manera clara y precoz

Background: 123I-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy is clinically used to estimate myocardial sympathetic damage in some forms of heart disease, autonomic nerve disturbance in diabetic neuropathy, and disturbance of the autonomic nervous system in neurodegenerative disease. In the present study, examinations were performed to clarify the rate and characteristics of cardiac sympathetic disturbance in Parkinson's disease (PD) and usefulness of 123I-MIBG myocardial scintigraphy to differentiate PD from the Lewy Body Disease (LBD). Material and methods: 108 subjects were studied. There were 70 patients with PD, 21 patients with LBD, and 17 age-matched normal subjects without neurological disease. The clinical parameters evaluated were severity of the process (measured by Hoehn and Yahr Scale), vegetative manifestations, development time and use of medication taken. Myocardial adrenergic function was analyzed by imaging with 123I-MIBG. Early (15 min) and delayed (4 h) images of the thorax in the anterior view were obtained after injection of 123I-MIBG (111 MBq). The qualitative and semiquantitative 123I-MIBG uptake was quantified by calculating a heart-to-mediastinum ratio (HMR) and analyzed in a blind manner. Results: The mean H/M ratio in patients with PD and LBD was significantly lower than in controls (p < 0.05). This is independent of development time, process severity, use of medication or vegetative manifestations. The HMR obtained in LBD patients is less clear than in PD. Conclusion: 123I-MIBG myocardial scintigraphy might detect early disturbances of the sympathetic nervous system in PD and LBD

[Early alteration of adrenergic cardiac function in parkinsonisms with Lewy bodies]. / Alteración precoz de la función adrenérgica cardíaca en los parkinsonismos con cuerpos de Lewy.

BACKGROUND: 123I-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy is clinically used to estimate myocardial sympathetic damage in some forms of heart disease, autonomic nerve disturbance in diabetic neuropathy, and disturbance of the autonomic nervous system in neurodegenerative disease. In the present study, examinations were performed to clarify the rate and characteristics of cardiac sympathetic disturbance in Parkinson's disease (PD) and usefulness of 123I-MIBG myocardial scintigraphy to differentiate PD from the Lewy Body Disease (LBD). MATERIAL AND METHODS: 108 subjects were studied. There were 70 patients with PD, 21 patients with LBD, and 17 age-matched normal subjects without neurological disease. The clinical parameters evaluated were severity of the process (measured by Hoehn and Yahr Scale), vegetative manifestations, development time and use of medication taken. Myocardial adrenergic function was analyzed by imaging with 123I-MIBG. Early (15 min) and delayed (4 h) images of the thorax in the anterior view were obtained after injection of 123I-MIBG (111 MBq). The qualitative and semiquantitative 123I-MIBG uptake was quantified by calculating a heart-to-mediastinum ratio (HMR) and analyzed in a blind manner. RESULTS: The mean H/M ratio in patients with PD and LBD was significantly lower than in controls (p < 0.05). This is independent of development time, process severity, use of medication or vegetative manifestations. The HMR obtained in LBD patients is less clear than in PD. CONCLUSION: 123I-MIBG myocardial scintigraphy might detect early disturbances of the sympathetic nervous system in PD and LBD.

Alteración precoz de la función adrenérgica cardíaca en la enfermedad de Parkinson / Early alterations of adrenergic cardiac function in Parkinson's disease

Introducción. La función simpática (adrenérgica) miocárdica está significativamente afectada en los pacientes con enfermedad de Parkinson idiopática (EP) como se deduce de la evaluación gammagráfica cardíaca con 1231-metayodobencilguanidina (1231-MIBG).Pacientes y métodos. Hemos estudiado 60 pacientes con EP comparándolos con 17 sujetos controles sin enfermedad neurológica. Los parámetros clínicos evaluados han sido la gravedad del proceso (medido por la Escala de Hoehn y Yahr), la existencia de manifestaciones vegetativas, el tiempo de evolución de la EP y el uso de tratamiento farmacológico y de qué tipo. Se ha analizado la función adrenérgica miocárdica mediante gammagrafía con 1231-MIBG, adquiriéndose con técnica planar imágenes de tórax anterior de forma precoz (a los 15 min postadministración del trazador) y tardía (a las 4 h). La captación miocárdica se ha valorado de forma cualitativa y semicuantitativa mediante la obtención de los índices corazón-mediastino (ICM).Resultados. Nuestros resultados han demostrado una marcada reducción de los ICM en los pacientes con EP en comparación con los controles (p < 0,01), independientemente del tiempo de evolución, severidad del proceso, uso de tratamiento farmacológico o existencia. de manifestaciones clínicas vegetativas. Conclusiones. En la EP existe una alteración noradrenérgica llamativa que puede apreciarse desde estadios precoces de la enfermedad y no parece existir en otros parkinsonismos secundarios a diferente mecanismo patogénico (AU)

[Early alterations of adrenergic cardiac function in Parkinson's disease]. / Alteración precoz de la función adrenérgica cardíaca en la enfermedad de Parkinson.

INTRODUCTION: Myocardial sympathetic (adrenergic) function is significantly affected in patients with idiopathic Parkinson's disease (PD) as is deduced from the cardiac scintigraphy evaluation with 123I-metaiodobenzylguanidine (123I-MIBG). PATIENTS AND METHODS: In the present study, 60 patients with PD were studied compared to 17 normal subject without neurological disease. The clinical parameters evaluated were severity of the condition (measured by Hoehn and Yahr Scale), vegetative manifestations, development time and use and type of medication taken. Myocardial adrenergic function was analyzed by imaging with 123I-MIBG. Early (15 min) and delayed (4 h) images of the anterior view were obtained after injection of 123I-MIBG. Qualitative and semiquantitative 123I-MIBG uptake was quantified by calculating a heart-to-mediastinum (H/M) ratio. RESULTS: We found a significant decrease of H/M ratio in patients with PD as compared with controls (p < 0.01) independently of development time, severity of the condition, use of medication or vegetative manifestations. CONCLUSIONS: There is an important noradrenergic alteration in PD, that can be detected from early stages and does not exist in other parkinsonisms caused by a different pathogenic mechanism.