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Floria M, Tanase DM. Left atrial autonomic remodeling and ganglionated plexi. J Clin Ultrasound 2024; 52:186-188. [PMID: 38054510 DOI: 10.1002/jcu.23615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Mariana Floria
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iași, Romania
- Internal Medicine Clinic, Sf. Spiridon Emergency Hospital, Iași, Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iași, Romania
- Internal Medicine Clinic, Sf. Spiridon Emergency Hospital, Iași, Romania
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Wludarczyk A, Domagalik A, Biedron G, Tutaj M, Łoboda P, Wawrzycka-Adamczyk K, Marek T, Sznajd J, Szczeklik W. Functional magnetic resonance imaging for the assessment of autonomic dysfunction in patients with antineutrophil cytoplasmic antibody-associated vasculitides. Pol Arch Intern Med 2023; 133:16533. [PMID: 37462400 DOI: 10.20452/pamw.16533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Nervous system involvement is common in antineutrophil cytoplasmic antibody-associated vasculitides (AAV). While the involvement of the peripheral and central nervous system is well described, it is still unclear how and to what extent the autonomic nervous system (ANS) is affected. Functional magnetic resonance imaging (fMRI) can provide information on both structure and potential damage of the brain, as well as on the function of selected brain centers. OBJECTIVES The aim of this study was to investigate the ANS dysfunction in AAV patients and its correlation with the results of fMRI performed during the Valsalva maneuver. PATIENTS AND METHODS A total of 31 patients with AAV and 30 healthy controls were enrolled in the study. Each participant completed the Composite Autonomic Symptom Score (COMPASS)-31 questionnaire. MRI was performed using a 3T scanner. The participants were asked to perform the Valsalva maneuver according to the fixed protocol, and their airway pressure was monitored. During the maneuver, fMRI data were collected. The generalized least‑ squares time series analysis and the region of interest (ROI) analysis were subsequently performed. RESULTS The patients with AAV had a higher median COMPASS‑ 31 score than the controls (12.86 vs 2.99, respectively; P <0.01). Structural MRI investigation did not reveal any significant differences between the groups. The brain centers involved in ANS function were detected during fMRI; however, the ROI analysis showed no differences between the study patients and controls. CONCLUSIONS The patients with AAV reported symptoms related to the ANS dysfunction; however, no differences with respect to the functioning of the ANS brain centers were demonstrated between these patients and healthy controls in the fMRI study during the Valsalva maneuver.
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Affiliation(s)
- Anna Wludarczyk
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
| | | | - Grzegorz Biedron
- Second Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Tutaj
- Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Łoboda
- Department of Diagnostic Imaging, University Hospital, Kraków, Poland
| | | | - Tadeusz Marek
- Institute of Psychology, University of Social Sciences and Humanities, Katowice, Poland
| | - Jan Sznajd
- Raigmore Hospital, NHS Highlands, Inverness, Scotland, United Kingdom
| | - Wojciech Szczeklik
- Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
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Hua AY, Roy ARK, Kosik EL, Morris NA, Chow TE, Lukic S, Montembeault M, Borghesani V, Younes K, Kramer JH, Seeley WW, Perry DC, Miller ZA, Rosen HJ, Miller BL, Rankin KP, Gorno-Tempini ML, Sturm VE. Diminished baseline autonomic outflow in semantic dementia relates to left-lateralized insula atrophy. Neuroimage Clin 2023; 40:103522. [PMID: 37820490 PMCID: PMC10582496 DOI: 10.1016/j.nicl.2023.103522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/28/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
In semantic dementia (SD), asymmetric degeneration of the anterior temporal lobes is associated with loss of semantic knowledge and alterations in socioemotional behavior. There are two clinical variants of SD: semantic variant primary progressive aphasia (svPPA), which is characterized by predominant atrophy in the anterior temporal lobe and insula in the left hemisphere, and semantic behavioral variant frontotemporal dementia (sbvFTD), which is characterized by predominant atrophy in those structures in the right hemisphere. Previous studies of behavioral variant frontotemporal dementia, an associated clinical syndrome that targets the frontal lobes and anterior insula, have found impairments in baseline autonomic nervous system activity that correlate with left-lateralized frontotemporal atrophy patterns and disruptions in socioemotional functioning. Here, we evaluated whether there are similar impairments in resting autonomic nervous system activity in SD that also reflect left-lateralized atrophy and relate to diminished affiliative behavior. A total of 82 participants including 33 people with SD (20 svPPA and 13 sbvFTD) and 49 healthy older controls completed a laboratory-based assessment of respiratory sinus arrhythmia (RSA; a parasympathetic measure) and skin conductance level (SCL; a sympathetic measure) during a two-minute resting baseline period. Participants also underwent structural magnetic resonance imaging, and informants rated their current affiliative behavior on the Interpersonal Adjective Scale. Results indicated that baseline RSA and SCL were lower in SD than in healthy controls, with significant impairments present in both svPPA and sbvFTD. Voxel-based morphometry analyses revealed left-greater-than-right atrophy related to diminished parasympathetic and sympathetic outflow in SD. While left-lateralized atrophy in the mid-to-posterior insula correlated with lower RSA, left-lateralized atrophy in the ventral anterior insula correlated with lower SCL. In SD, lower baseline RSA, but not lower SCL, was associated with lower gregariousness/extraversion. Neither autonomic measure related to warmth/agreeableness, however. Through the assessment of baseline autonomic nervous system physiology, the present study contributes to expanding conceptualizations of the biological basis of socioemotional alterations in svPPA and sbvFTD.
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Affiliation(s)
- Alice Y Hua
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Ashlin R K Roy
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Eena L Kosik
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Nathaniel A Morris
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Tiffany E Chow
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Sladjana Lukic
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Maxime Montembeault
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | | | - Kyan Younes
- Department of Neurology, Stanford Neuroscience Health Center, Palo Alto, CA, USA
| | - Joel H Kramer
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - William W Seeley
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - David C Perry
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Zachary A Miller
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Howard J Rosen
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Bruce L Miller
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Katherine P Rankin
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA
| | - Virginia E Sturm
- Department of Neurology, University of California, San Francisco, Memory and Aging Center, San Francisco, CA, USA.
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Thorne J, Hellewell S, Cowen G, Fitzgerald M. Neuroimaging to enhance understanding of cardiovascular autonomic changes associated with mild traumatic brain injury: a scoping review. Brain Inj 2023; 37:1187-1204. [PMID: 37203154 DOI: 10.1080/02699052.2023.2211352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/19/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Cardiovascular changes, such as altered heart rate and blood pressure, have been identified in some individuals following mild traumatic brain injury (mTBI) and may be related to disturbances of the autonomic nervous system and cerebral blood flow. METHODS We conducted a scoping review according to PRISMA-ScR guidelines across six databases (Medline, CINAHL, Web of Science, PsychInfo, SportDiscus and Google Scholar) to explore literature examining both cardiovascular parameters and neuroimaging modalities following mTBI, with the aim of better understanding the pathophysiological basis of cardiovascular autonomic changes associated with mTBI. RESULTS Twenty-nine studies were included and two main research approaches emerged from data synthesis. Firstly, more than half the studies used transcranial Doppler ultrasound and found evidence of cerebral blood flow impairments that persisted beyond symptom resolution. Secondly, studies utilizing advanced MRI identified microstructural injury within brain regions responsible for cardiac autonomic function, providing preliminary evidence that cardiovascular autonomic changes are a consequence of injury to these areas. CONCLUSION Neuroimaging modalities hold considerable potential to aid understanding of the complex relationship between cardiovascular changes and brain pathophysiology associated with mTBI. However, it is difficult to draw definitive conclusions from the available data due to variability in study methodology and terminology.
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Affiliation(s)
- Jacinta Thorne
- School of Allied Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Sarah Hellewell
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Gill Cowen
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Melinda Fitzgerald
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
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Jung HW, Kim HY, Kim JY, Cheon JE, Kim IO, Kim SK, Shin CH, Yang SW, Lee YA. Cardiac autonomic dysfunction is associated with hypothalamic damage in patients with childhood-onset craniopharyngioma. PLoS One 2021; 16:e0246789. [PMID: 33591998 PMCID: PMC7886170 DOI: 10.1371/journal.pone.0246789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 01/26/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Autonomic nervous system dysfunction is implicated in the development of hypothalamic obesity. We investigated the relationship between hypothalamic involvement (HI), central obesity, and cardiac autonomic dysfunction by assessing heart rate variability (HRV) indices in patients with childhood-onset craniopharyngioma. METHODS A cross-sectional study of 48 patients (28 males, 10-30 years old) with hypothalamic damage after childhood-onset craniopharyngioma was performed. Postoperative HI was graded as mild (n = 19) or extensive (n = 29) on magnetic resonance imaging. Anthropometry, body composition and HRV indices including the standard deviation of all normal R-R intervals (SDNN) and total power (TP) as overall variability markers, root-mean square differences of successive R-R intervals (RMSSD) and high frequency (HF) as parasympathetic modulation markers, and low frequency (LF) as a sympathetic/sympathovagal modulation marker were measured. RESULTS Patients with extensive HI had increased means of body mass index, waist circumference, and fat mass than those with mild HI (P < 0.05, for all). Centrally obese patients had a lower mean HF, a parasympathetic modulation marker, than centrally non-obese patients (P < 0.05). The extensive HI group had lower means of overall variability (SDNN and TP), parasympathetic modulation (HF), and sympathetic/sympathovagal modulation (LF) than the mild HI group (P < 0.05, for all). The interaction effect of HI and central obesity on HRV indices was not significant. In models adjusted for age, sex, and family history of cardiometabolic disease, the means of the overall variability indices (P < 0.05 for both SDNN and TP) and a sympathetic/sympathovagal modulation index (P < 0.05 for LF) were lower with extensive HI, without differences according to central obesity. CONCLUSIONS The reduced HRV indices with extensive HI suggests that hypothalamic damage may contribute to cardiac autonomic dysfunction, underscoring the importance of minimizing hypothalamic damage in patients with childhood-onset craniopharyngioma.
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Affiliation(s)
- Hae Woon Jung
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Hwa Young Kim
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Young Kim
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In-One Kim
- Department of Radiology, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Abstract
Although first described over a hundred years ago, tissue optical clearing is undergoing renewed interest due to numerous advances in optical clearing methods, microscopy systems, and three-dimensional (3-D) image analysis programs. These advances are advantageous for intact mouse tissues or pieces of human tissues because samples sized several millimeters can be studied. Optical clearing methods are particularly useful for studies of the neuroanatomy of the central and peripheral nervous systems and tissue vasculature or lymphatic system. Using examples from solvent- and aqueous-based optical clearing methods, the mouse and human pancreatic structures and networks will be reviewed in 3-D for neuro-insular complexes, parasympathetic ganglia, and adipocyte infiltration as well as lymphatics in diabetes. Optical clearing with multiplex immunofluorescence microscopy provides new opportunities to examine the role of the nervous and circulatory systems in pancreatic and islet functions by defining their neurovascular anatomy in health and diabetes.
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Affiliation(s)
- Martha Campbell-Thompson
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
- *Correspondence: Martha Campbell-Thompson, ; Shiue-Cheng Tang,
| | - Shiue-Cheng Tang
- Department of Medical Science and Institute of Biotechnology, National Tsing Hua University, Hsinchu, Taiwan
- *Correspondence: Martha Campbell-Thompson, ; Shiue-Cheng Tang,
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Kazmi SZH, Habib N, Riaz R, Rizvi SS, Abbas SA, Chung TS. Multiscale based nonlinear dynamics analysis of heart rate variability signals. PLoS One 2020; 15:e0243441. [PMID: 33332361 PMCID: PMC7746153 DOI: 10.1371/journal.pone.0243441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/21/2020] [Indexed: 11/18/2022] Open
Abstract
Acceleration change index (ACI) is a fast and easy to understand heart rate variability (HRV) analysis approach used for assessing cardiac autonomic control of the nervous systems. The cardiac autonomic control of the nervous system is an example of highly integrated systems operating at multiple time scales. Traditional single scale based ACI did not take into account multiple time scales and has limited capability to classify normal and pathological subjects. In this study, a novel approach multiscale ACI (MACI) is proposed by incorporating multiple time scales for improving the classification ability of ACI. We evaluated the performance of MACI for classifying, normal sinus rhythm (NSR), congestive heart failure (CHF) and atrial fibrillation subjects. The findings reveal that MACI provided better classification between healthy and pathological subjects compared to ACI. We also compared MACI with other scale-based techniques such as multiscale entropy, multiscale permutation entropy (MPE), multiscale normalized corrected Shannon entropy (MNCSE) and multiscale permutation entropy (IMPE). The preliminary results show that MACI values are more stable and reliable than IMPE and MNCSE. The results show that MACI based features lead to higher classification accuracy.
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Affiliation(s)
- Syed Zaki Hassan Kazmi
- Department of Computer Science & Information Technology, University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan
| | - Nazneen Habib
- Department of Sociology & Rural Development, University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan
| | - Rabia Riaz
- Department of Computer Science & Information Technology, University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan
| | | | - Syed Ali Abbas
- Department of Computer Science & Information Technology, University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan
| | - Tae-Sun Chung
- Department of Software, Ajou University, Suwon, South Korea
- * E-mail:
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De Paepe KN, Higgins DM, Ball I, Morgan VA, Barton DP, deSouza NM. Visualizing the autonomic and somatic innervation of the female pelvis with 3D MR neurography: a feasibility study. Acta Radiol 2020; 61:1668-1676. [PMID: 32212832 PMCID: PMC7720358 DOI: 10.1177/0284185120909337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment of female pelvic malignancies often causes pelvic nerve damage. Magnetic resonance (MR) neurography mapping the female pelvic innervation could aid in treatment planning. PURPOSE To depict female autonomic and somatic pelvic innervation using a modified 3D NerveVIEW sequence. MATERIAL AND METHODS Prospective study in 20 female volunteers (n = 6 normal, n = 14 cervical pathology) who underwent a modified 3D short TI inversion recovery (STIR) turbo spin-echo (TSE) scan with a motion-sensitive driven equilibrium (MSDE) preparation radiofrequency pulse and flow compensation. Modifications included offset independent trapezoid (OIT) pulses for inversion and MSDE refocusing. Maximum intensity projections (MIP) were evaluated by two observers (Observer 1, Observer 2); image quality was scored as 2 = high, 1 = medium, or 0 = low with the sciatic nerve serving as a reference. Conspicuity of autonomic superior (SHP) and bilateral inferior hypogastric plexuses (IHP), hypogastric nerves, and somatic pelvic nerves (sciatic, pudendal) was scored as 2 = well-defined, 1 = poorly defined, or 0 = not seen, and inter-observer agreement was determined. RESULTS Images were of medium to high quality according to both observers agreeing in 15/20 (75%) of individuals. SHP and bilateral hypogastric nerves were seen in 30/60 (50%) of cases by both observers. Bilateral IHP was seen in 85% (34/40) by Observer 1 and in 75% (30/40) by Observer 2. Sciatic nerves were well identified in all cases, while pudendal nerves were seen bilaterally by Observer 1 in 65% (26/40) and by Observer 2 in 72.5% (29/40). Agreement between observers for scoring nerve conspicuity was in the range of 60%-100%. CONCLUSION Modified 3D NerveVIEW renders high-quality images of the female autonomic and pudendal nerves.
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Affiliation(s)
- Katja N De Paepe
- The Institute of Cancer Research, Division of Radiotherapy and Imaging, Sutton, UK
- The Royal Marsden NHS Foundation Trust, Department of Radiology, London, UK
| | | | | | - Veronica A Morgan
- The Royal Marsden NHS Foundation Trust, Department of Radiology, London, UK
| | - Desmond P Barton
- The Royal Marsden NHS Foundation Trust, Department of Gynecological Oncology, London, UK
| | - Nandita M deSouza
- The Institute of Cancer Research, Division of Radiotherapy and Imaging, Sutton, UK
- The Royal Marsden NHS Foundation Trust, Department of Radiology, London, UK
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Bengtsson J, Bodén R, Olsson EMG, Mårtensson J, Gingnell M, Persson J. Autonomic modulation networks in schizophrenia: The relationship between heart rate variability and functional and structural connectivity in the brain. Psychiatry Res Neuroimaging 2020; 300:111079. [PMID: 32283474 DOI: 10.1016/j.pscychresns.2020.111079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/30/2022]
Abstract
Heart rate variability (HRV), a measurement of autonomic nervous system (ANS) activity, has been found reduced in schizophrenia. The anterior cingulate cortex (ACC), which is important in regulating the ANS, is structurally and functionally affected in schizophrenia. We investigate the relationship between HRV and functional and structural connectivity of the ACC in patients with schizophrenia and healthy controls. Ten patients with a diagnosis of schizophrenia and ten healthy controls were recruited. Heart rate was monitored in a naturalistic out-of-clinic setting. Magnetic resonance imaging (MRI) was performed, including resting-state functional MRI and diffusion tensor imaging. Patients with schizophrenia had significantly lower HRV compared to controls. A positive correlation between ACC connectivity with the bilateral cerebellum and HRV was found in the patients. HRV was also positively correlated with amplitude of low frequency fluctuations (ALFF) in the cerebellum, and with axial diffusivity in the middle cerebellar peduncle, in the patients. There was a significant negative relationship between antipsychotic medication dosage, HRV and all neuroimaging measures related to HRV. We conclude that ACC connectivity seems to be affected in schizophrenia, both structurally and functionally, and that the ACC-cerebellum connectivity, as well as cerebellar function, is associated with ANS regulation in patients with schizophrenia.
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Affiliation(s)
- J Bengtsson
- Dept. of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
| | - R Bodén
- Dept. of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - E M G Olsson
- Dept. of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - J Mårtensson
- Dept. of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden; Dept. of Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - M Gingnell
- Dept. of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - J Persson
- Dept. of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Maksoud R, du Preez S, Eaton-Fitch N, Thapaliya K, Barnden L, Cabanas H, Staines D, Marshall-Gradisnik S. A systematic review of neurological impairments in myalgic encephalomyelitis/ chronic fatigue syndrome using neuroimaging techniques. PLoS One 2020; 15:e0232475. [PMID: 32353033 PMCID: PMC7192498 DOI: 10.1371/journal.pone.0232475] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/15/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Myalgic encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) is a multi-system illness characterised by a diverse range of debilitating symptoms including autonomic and cognitive dysfunction. The pathomechanism remains elusive, however, neurological and cognitive aberrations are consistently described. This systematic review is the first to collect and appraise the literature related to the structural and functional neurological changes in ME/CFS patients as measured by neuroimaging techniques and to investigate how these changes may influence onset, symptom presentation and severity of the illness. METHODS A systematic search of databases Pubmed, Embase, MEDLINE (via EBSCOhost) and Web of Science (via Clarivate Analytics) was performed for articles dating between December 1994 and August 2019. Included publications report on neurological differences in ME/CFS patients compared with healthy controls identified using neuroimaging techniques such as magnetic resonance imaging, positron emission tomography and electroencephalography. Article selection was further refined based on specific inclusion and exclusion criteria. A quality assessment of included publications was completed using the Joanna Briggs Institute checklist. RESULTS A total of 55 studies were included in this review. All papers assessed neurological or cognitive differences in adult ME/CFS patients compared with healthy controls using neuroimaging techniques. The outcomes from the articles include changes in gray and white matter volumes, cerebral blood flow, brain structure, sleep, EEG activity, functional connectivity and cognitive function. Secondary measures including symptom severity were also reported in most studies. CONCLUSIONS The results suggest widespread disruption of the autonomic nervous system network including morphological changes, white matter abnormalities and aberrations in functional connectivity. However, these findings are not consistent across studies and the origins of these anomalies remain unknown. Future studies are required confirm the potential neurological contribution to the pathology of ME/CFS.
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Affiliation(s)
- Rebekah Maksoud
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
- * E-mail:
| | - Stanley du Preez
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
- School of Medical Sciences, Griffith University, Gold Coast, Australia
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Natalie Eaton-Fitch
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
- School of Medical Sciences, Griffith University, Gold Coast, Australia
| | - Kiran Thapaliya
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
| | - Leighton Barnden
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
| | - Hélène Cabanas
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
| | - Donald Staines
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
| | - Sonya Marshall-Gradisnik
- National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Consortium Health International for Myalgic Encephalomyelitis, Griffith University, Gold Coast, Australia
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Jeong YJ, Jeong JE, Cheon SM, Yoon BA, Kim JW, Kang DY. Relationship between the washout rate of I-123 MIBG scans and autonomic function in Parkinson's disease. PLoS One 2020; 15:e0229860. [PMID: 32134983 PMCID: PMC7058312 DOI: 10.1371/journal.pone.0229860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/19/2020] [Indexed: 01/18/2023] Open
Abstract
Purpose We have evaluated the clinical significance of the washout rate (WR) on I-123 MIBG scans through the analysis of the relationship between the I-123 MIBG scans and autonomic status in patients with Parkinson’s disease (PD). Materials and methods Sixty patients with clinical PD who had decreased HMR were enrolled. An autonomic symptom was evaluated using a head-up tilt test and the Composite Autonomic Severity Score (CASS). An I-123 MIBG scan and F-18 FP-CIT positron emission tomography (PET) were performed. All of the patients were classified into three groups according to the WR. The differences in patient characteristics and the imaging parameters among the three groups were evaluated, and a correlation analysis was also performed. Results The frequency of orthostatic hypotension was significantly different among the three groups. The difference in systolic pressure (dSysPr) and the difference in diastolic pressure (dDiaPr) of group 3 was significantly larger than those of groups 1 and 2. From the correlation analysis, it can be seen that age, Hoehn and Yahr (H&Y) stage, dSysPr, and dDiaPr had a weak positive correlation with the WR. The total CASS score was significantly higher in group 3 compared with groups 1 and 2. The WR had a moderate positive correlation with the cardiosympathetic score and the total CASS score. Conclusion The WR is related to autonomic dysfunction. An I-123 MIBG cardiac scan is considered to be a good method to evaluate not only the differential diagnosis of Parkinson's disease but also the degree of autonomic dysfunction.
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Affiliation(s)
- Young Jin Jeong
- Departments of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
- Institute of Convergence Bio-Health, Dong-A University, Busan, Republic of Korea
| | - Ji-Eun Jeong
- Departments of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Sang-Myung Cheon
- Departments of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Byeol-A Yoon
- Departments of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jae Woo Kim
- Departments of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Do-Young Kang
- Departments of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
- Institute of Convergence Bio-Health, Dong-A University, Busan, Republic of Korea
- * E-mail:
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12
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Zhou W, Chen J, Chen J, Wang L, Li Y, Deng N, Tang Q, Wu L, Zhou B, Li W. Study of the Distribution of Epicardial Vagal Ganglion and the Relationship Between Delayed Enhancement Magnetic Resonance Imaging and Radiofrequency Ablation in Patients with Atrial Fibrillation. World Neurosurg 2020; 138:732-739. [PMID: 31931252 DOI: 10.1016/j.wneu.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 11/17/2022]
Abstract
This article presents a retrospective study of patients undergoing radiofrequency ablation of atrial fibrillation (AF); analyzes the characteristics of heart rate variability (HRV) in patients; and explores the role of delayed enhancement magnetic resonance imaging and autonomic nervous system function, changes in autonomic nervous system function, and recurrence of AF after radiofrequency ablation to understand the effect of denervation of the autonomic nervous system on the efficacy of radiofrequency ablation of AF. The study found that there were no significant differences in clinical baseline characteristics, mean heart rate, and HRV indicators between patients without relapse and patients with relapse (P > 0.05). The overall HRV index was significantly reduced after surgery as well as before surgery. In the relapse-free group, the high-frequency power that responded to vagal tone was more significant, the low-frequency/high-frequency power ratio increased, and other HRV indicators were significantly reduced; in the relapse group, mean heart rate increased, sympathetic response to the low-frequency power of nerve tension was significantly reduced, and the low-frequency/high-frequency power ratio was decreased. The difference was statistically significant (P < 0.05). Therefore, sympathetic and parasympathetic nerve function were significantly reduced after radiofrequency ablation of the pulmonary veins in patients with AF. Reducing vagus nerve tension may inhibit early recurrence of paroxysmal AF in patients after left atrial ring pulmonary vein ablation.
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Affiliation(s)
- Wei Zhou
- Department of Cardiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jiulin Chen
- Department of Cardiology, Qian Xi Nan People's Hospital, Qian Xi Nan, China
| | - Jingjing Chen
- Department of Cardiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Long Wang
- Department of Cardiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yongkang Li
- Department of Cardiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Na Deng
- Department of Cardiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Qian Tang
- Department of Cardiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Lirong Wu
- Department of Cardiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Bo Zhou
- Department of Cardiology, Bijie First Municipal People's Hospital, Bijie, Guizhou, China
| | - Wei Li
- Department of Cardiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
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13
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Sturm VE, Brown JA, Hua AY, Lwi SJ, Zhou J, Kurth F, Eickhoff SB, Rosen HJ, Kramer JH, Miller BL, Levenson RW, Seeley WW. Network Architecture Underlying Basal Autonomic Outflow: Evidence from Frontotemporal Dementia. J Neurosci 2018; 38:8943-8955. [PMID: 30181137 PMCID: PMC6191520 DOI: 10.1523/jneurosci.0347-18.2018] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 12/22/2022] Open
Abstract
The salience network is a distributed neural system that maintains homeostasis by regulating autonomic nervous system activity and social-emotional function. Here we examined how within-network connectivity relates to individual differences in human (including males and females) baseline parasympathetic and sympathetic nervous activity. We measured resting autonomic nervous system physiology in 24 healthy controls and 23 patients with behavioral variant frontotemporal dementia (bvFTD), a neurodegenerative disease characterized by baseline autonomic deficits. Participants also underwent structural and task-free fMRI. First, we used voxel-based morphometry to determine whether salience network atrophy was associated with lower baseline respiratory sinus arrhythmia (a parasympathetic measure) and skin conductance level (a sympathetic measure) in bvFTD. Next, we examined whether functional connectivity deficits in 21 autonomic-relevant, salience network node-pairs related to baseline autonomic dysfunction. Lower baseline respiratory sinus arrhythmia was associated with smaller volume in left ventral anterior insula (vAI), weaker connectivity between bilateral vAI and bilateral anterior cingulate cortex (ACC), and stronger connectivity between bilateral ACC and bilateral hypothalamus/amygdala. Lower baseline skin conductance level, in contrast, was associated with smaller volume in inferior temporal gyrus, dorsal mid-insula, and hypothalamus; weaker connectivity between bilateral ACC and right hypothalamus/amygdala; and stronger connectivity between bilateral dorsal anterior insula and periaqueductal gray. Our results suggest that baseline parasympathetic and sympathetic tone depends on the integrity of lateralized salience network hubs (left vAI for parasympathetic and right hypothalamus/amygdala for sympathetic) and highly calibrated ipsilateral and contralateral network connections. In bvFTD, deficits in this system may underlie resting parasympathetic and sympathetic disruption.SIGNIFICANCE STATEMENT The salience network maintains homeostasis and regulates autonomic nervous system activity. Whether within-network connectivity patterns underlie individual differences in resting parasympathetic and sympathetic nervous system activity, however, is not well understood. We measured baseline autonomic nervous system activity in healthy controls and patients with behavioral variant frontotemporal dementia, a neurodegenerative disease characterized by resting autonomic deficits, and probed how salience network dysfunction relates to diminished parasympathetic and sympathetic outflow. Our results indicate that baseline parasympathetic and sympathetic tone are the product of complex, opposing intranetwork nodal interactions and depend on the integrity of highly tuned, lateralized salience network hubs (i.e., left ventral anterior insula for parasympathetic activity and right hypothalamus/amygdala for sympathetic activity).
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Affiliation(s)
- Virginia E Sturm
- Department of Neurology, University of California-San Francisco, Sandler Neurosciences Center, San Francisco, California 94158
| | - Jesse A Brown
- Department of Neurology, University of California-San Francisco, Sandler Neurosciences Center, San Francisco, California 94158
| | - Alice Y Hua
- Department of Psychology, University of California, Berkeley, California 94720-1650
| | - Sandy J Lwi
- Department of Psychology, University of California, Berkeley, California 94720-1650
| | - Juan Zhou
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857
| | - Florian Kurth
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles School of Medicine, Los Angeles, California 90095
| | - Simon B Eickhoff
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine Universität, 40225 Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour, Research Centre Jülich, Jülich, 52425, Germany, and
| | - Howard J Rosen
- Department of Neurology, University of California-San Francisco, Sandler Neurosciences Center, San Francisco, California 94158
| | - Joel H Kramer
- Department of Neurology, University of California-San Francisco, Sandler Neurosciences Center, San Francisco, California 94158
| | - Bruce L Miller
- Department of Neurology, University of California-San Francisco, Sandler Neurosciences Center, San Francisco, California 94158
| | - Robert W Levenson
- Department of Psychology, University of California, Berkeley, California 94720-1650
| | - William W Seeley
- Department of Neurology, University of California-San Francisco, Sandler Neurosciences Center, San Francisco, California 94158,
- Department of Pathology, University of California, San Francisco, California 94143
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14
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Abstract
PURPOSE OF REVIEW Patients with Parkinson's disease (PD) often display gastrointestinal and genitourinary autonomic symptoms years or even decades prior to diagnosis. These symptoms are thought to be caused in part by pathological α-synuclein inclusions in the peripheral autonomic and enteric nervous systems. It has been proposed that the initial α-synuclein aggregation may in some PD patients originate in peripheral nerve terminals and then spread centripetally to the spinal cord and brainstem. In vivo imaging methods can directly quantify the degeneration of the autonomic nervous system as well as the functional consequences such as perturbed motility. Here, we review the methodological principles of these imaging techniques and the major findings in patients with PD and atypical parkinsonism. RECENT FINDINGS Loss of sympathetic and parasympathetic nerve terminals in PD can be visualized using radiotracer imaging, including 123I-MIBG scintigraphy, and 18F-dopamine and 11C-donepezil PET. Recently, ultrasonographical studies disclosed reduced diameter of the vagal nerves in PD patients. Radiological and radioisotope techniques have demonstrated dysmotility and prolonged transit time throughout all subdivisions of the gastrointestinal tract in PD. The prevalence of objective dysfunction as measured with these imaging methods is often considerably higher compared to the prevalence of subjective symptoms experienced by the patients. Degeneration of the autonomic nervous system may play a key role in the pathogenesis of PD. In vivo imaging techniques provide powerful and noninvasive tools to quantify the degree and extent of this degeneration and its functional consequences.
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Affiliation(s)
- Karoline Knudsen
- Department of Nuclear Medicine and PET Centre Aarhus University Hospital, Institute of Clinical Medicine Aarhus University, Norrebrogade 44, Building 10, 8000, Aarhus C, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine and PET Centre Aarhus University Hospital, Institute of Clinical Medicine Aarhus University, Norrebrogade 44, Building 10, 8000, Aarhus C, Denmark.
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15
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Ruffle JK, Coen SJ, Giampietro V, Williams SC, Apkarian AV, Farmer AD, Aziz Q. Morphology of subcortical brain nuclei is associated with autonomic function in healthy humans. Hum Brain Mapp 2018; 39:381-392. [PMID: 29080228 PMCID: PMC6866383 DOI: 10.1002/hbm.23850] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 09/19/2017] [Accepted: 10/09/2017] [Indexed: 12/11/2022] Open
Abstract
The autonomic nervous system (ANS) is a brain body interface which serves to maintain homeostasis by influencing a plethora of physiological processes, including metabolism, cardiorespiratory regulation and nociception. Accumulating evidence suggests that ANS function is disturbed in numerous prevalent clinical disorders, including irritable bowel syndrome and fibromyalgia. While the brain is a central hub for regulating autonomic function, the association between resting autonomic activity and subcortical morphology has not been comprehensively studied and thus was our aim. In 27 healthy subjects [14 male and 13 female; mean age 30 years (range 22-53 years)], we quantified resting ANS function using validated indices of cardiac sympathetic index (CSI) and parasympathetic cardiac vagal tone (CVT). High resolution structural magnetic resonance imaging scans were acquired, and differences in subcortical nuclei shape, that is, 'deformation', contingent on resting ANS activity were investigated. CSI positively correlated with outward deformation of the brainstem, right nucleus accumbens, right amygdala and bilateral pallidum (all thresholded to corrected P < 0.05). In contrast, parasympathetic CVT negatively correlated with inward deformation of the right amygdala and pallidum (all thresholded to corrected P < 0.05). Left and right putamen volume positively correlated with CVT (r = 0.62, P = 0.0047 and r = 0.59, P = 0.008, respectively), as did the brainstem (r = 0.46, P = 0.049). These data provide novel evidence that resting autonomic state is associated with differences in the shape and volume of subcortical nuclei. Thus, subcortical morphological brain differences in various disorders may partly be attributable to perturbation in autonomic function. Further work is warranted to investigate these findings in clinical populations. Hum Brain Mapp 39:381-392, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- James K. Ruffle
- Centre for Neuroscience and TraumaBlizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield StreetLondonE1 2AJUnited Kingdom
- Medical Acute Assessment Unit, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, WhitechapelLondonE1 1BBUnited Kingdom
| | - Steven J. Coen
- Research Department of Clinical, Educational and Health PsychologyUniversity College London, Gower StreetLondonWC1E 6BTUnited Kingdom
| | - Vincent Giampietro
- Department of NeuroimagingKing's College London, Institute of Psychiatry, Psychology & NeuroscienceLondonSE5 8AFUnited Kingdom
| | - Steven C.R. Williams
- Department of NeuroimagingKing's College London, Institute of Psychiatry, Psychology & NeuroscienceLondonSE5 8AFUnited Kingdom
| | - A. Vania Apkarian
- Department of PhysiologyNorthwestern University, Feinberg School of MedicineChicagoIllinois60611
| | - Adam D. Farmer
- Centre for Neuroscience and TraumaBlizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield StreetLondonE1 2AJUnited Kingdom
- Department of GastroenterologyUniversity Hospitals Midlands NHS Trust, Stoke on TrentStaffordshireST4 6QGUnited Kingdom
| | - Qasim Aziz
- Centre for Neuroscience and TraumaBlizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, 26 Ashfield StreetLondonE1 2AJUnited Kingdom
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16
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Abstract
The autonomic nervous system plays a key role in regulating changes in the cardiovascular system and its adaptation to various human body functions. The sympathetic arm of the autonomic nervous system is associated with the fight and flight response, while the parasympathetic division is responsible for the restorative effects on heart rate, blood pressure, and contractility. Disorders involving these two divisions can lead to, and are seen as, a manifestation of most common cardiovascular disorders. Over the last few decades, extensive research has been performed establishing imaging techniques to quantify the autonomic dysfunction associated with various cardiovascular disorders. Additionally, several techniques have been tested with variable success in modulating the cardiac autonomic nervous system as treatment for these disorders. In this review, we summarize basic anatomy, physiology, and pathophysiology of the cardiac autonomic nervous system including adrenergic receptors. We have also discussed several imaging modalities available to aid in diagnosis of cardiac autonomic dysfunction and autonomic modulation techniques, including pharmacologic and device-based therapies, that have been or are being tested currently.
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Affiliation(s)
- Hina K Jamali
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, P.O. Box 670542, Cincinnati, OH, USA
| | - Fahad Waqar
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, P.O. Box 670542, Cincinnati, OH, USA
| | - Myron C Gerson
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, P.O. Box 670542, Cincinnati, OH, USA.
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17
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Thackeray JT, Bengel FM. PET imaging of the autonomic nervous system. Q J Nucl Med Mol Imaging 2016; 60:362-382. [PMID: 27611712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The autonomic nervous system is the primary extrinsic control of heart rate and contractility, and is subject to adaptive and maladaptive changes in cardiovascular disease. Consequently, noninvasive assessment of neuronal activity and function is an attractive target for molecular imaging. A myriad of targeted radiotracers have been developed over the last 25 years for imaging various components of the sympathetic and parasympathetic signal cascades. While routine clinical use remains somewhat limited, a number of larger scale studies in recent years have supplied momentum to molecular imaging of autonomic signaling. Specifically, the findings of the ADMIRE HF trial directly led to United States Food and Drug Administration approval of 123I-metaiodobenzylguanidine (MIBG) for Single Photon Emission Computed Tomography (SPECT) assessment of sympathetic neuronal innervation, and comparable results have been reported using the analogous PET agent 11C-meta-hydroxyephedrine (HED). Due to the inherent capacity for dynamic quantification and higher spatial resolution, regional analysis may be better served by PET. In addition, preliminary clinical and extensive preclinical experience has provided a broad foundation of cardiovascular applications for PET imaging of the autonomic nervous system. Recent years have witnessed the growth of novel quantification techniques, expansion of multiple tracer studies, and improved understanding of the uptake of different radiotracers, such that the transitional biology of dysfunctional subcellular catecholamine handling can be distinguished from complete denervation. As a result, sympathetic neuronal molecular imaging is poised to play a role in individualized patient care, by stratifying cardiovascular risk, visualizing underlying biology, and guiding and monitoring therapy.
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Affiliation(s)
- James T Thackeray
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany -
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18
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Chumaeva N, Hintsanen M, Pulkki-Råback L, Merjonen P, Elovainio M, Hintsa T, Juonala M, Kähönen M, Raitakari OT, Keltikangas-Järvinen L. Stress-induced cardiac autonomic reactivity and preclinical atherosclerosis: does arterial elasticity modify the association? Stress 2015; 18:622-30. [PMID: 26365028 DOI: 10.3109/10253890.2015.1078307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The effect of acute mental stress on atherosclerosis can be estimated using arterial elasticity measured by carotid artery distensibility (Cdist). We examined the interactive effect of acute stress-induced cardiac reactivity and Cdist to preclinical atherosclerosis assessed by carotid intima-media thickness (IMT) in 58 healthy adults aged 24-39 years participated in the epidemiological Young Finns Study. Cdist and IMT were measured ultrasonographically. Impedance electrocardiography was used to measure acute mental stress-induced cardiac autonomic responses: heart rate (HR), respiratory sinus arrhythmia and pre-ejection period after the mental arithmetic and the public speaking tasks. Interactions between HR reactivity and Cdist in relation to preclinical atherosclerosis were found. The results imply that elevated HR reactivity to acute mental stress is related to less atherosclerosis among healthy participants with higher arterial elasticity. Possibly, increased cardiac reactivity in response to challenging tasks is an adaptive reaction related to better cardiovascular health.
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Affiliation(s)
- Nadja Chumaeva
- a Institute of Behavioural Sciences, University of Helsinki , Helsinki , Finland
| | | | - Laura Pulkki-Råback
- a Institute of Behavioural Sciences, University of Helsinki , Helsinki , Finland
- c Helsinki Collegium for Advanced Studies , Helsinki , Finland
| | - Päivi Merjonen
- a Institute of Behavioural Sciences, University of Helsinki , Helsinki , Finland
| | - Marko Elovainio
- a Institute of Behavioural Sciences, University of Helsinki , Helsinki , Finland
- d National Institute for Health and Welfare , Helsinki , Finland
| | - Taina Hintsa
- a Institute of Behavioural Sciences, University of Helsinki , Helsinki , Finland
| | - Markus Juonala
- e Department of Medicine , University of Turku , Turku , Finland
- f Division of Medicine , Turku University Hospital , Turku , Finland
- g Murdoch Children's Research Institute , Parkville , Victoria , Australia
| | - Mika Kähönen
- h Department of Clinical Physiology , Tampere University Hospital, and University of Tampere , Tampere , Finland
| | - Olli T Raitakari
- i Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku , Turku , Finland , and
- j Department of Clinical Physiology and Nuclear Medicine , Turku University Hospital , Turku , Finland
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Johnson TL, Tulis DA, Keeler BE, Virag JA, Lust RM, Clemens S. The dopamine D3 receptor knockout mouse mimics aging-related changes in autonomic function and cardiac fibrosis. PLoS One 2013; 8:e74116. [PMID: 24023697 PMCID: PMC3758275 DOI: 10.1371/journal.pone.0074116] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/29/2013] [Indexed: 01/11/2023] Open
Abstract
Blood pressure increases with age, and dysfunction of the dopamine D3 receptor has been implicated in the pathogenesis of hypertension. To evaluate the role of the D3 receptor in aging-related hypertension, we assessed cardiac structure and function in differently aged (2 mo, 1 yr, 2 yr) wild type (WT) and young (2 mo) D3 receptor knockout mice (D3KO). In WT, systolic and diastolic blood pressures and rate-pressure product (RPP) significantly increased with age, while heart rate significantly decreased. Blood pressure values, heart rate and RPP of young D3KO were significantly elevated over age-matched WT, but similar to those of the 2 yr old WT. Echocardiography revealed that the functional measurements of ejection fraction and fractional shortening decreased significantly with age in WT and that they were significantly smaller in D3KO compared to young WT. Despite this functional change however, cardiac morphology remained similar between the age-matched WT and D3KO. Additional morphometric analyses confirmed an aging-related increase in left ventricle (LV) and myocyte cross-sectional areas in WT, but found no difference between age-matched young WT and D3KO. In contrast, interstitial fibrosis, which increased with age in WT, was significantly elevated in the D3KO over age-matched WT, and similar to 2 yr old WT. Western analyses of myocardial homogenates revealed significantly increased levels of pro- and mature collagen type I in young D3KO. Column zymography revealed that activities of myocardial MMP-2 and MMP-9 increased with age in WTs, but in D3KO, only MMP-9 activity was significantly increased over age-matched WTs. Our data provide evidence that the dopamine D3 receptor has a critical role in the emergence of aging-related cardiac fibrosis, remodeling, and dysfunction.
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Affiliation(s)
- Tracy L. Johnson
- Brody School of Medicine, Department of Physiology, East Carolina University, Greenville, North Carolina, United States of America
| | - David A. Tulis
- Brody School of Medicine, Department of Physiology, East Carolina University, Greenville, North Carolina, United States of America
| | - Benjamin E. Keeler
- Brody School of Medicine, Department of Physiology, East Carolina University, Greenville, North Carolina, United States of America
| | - Jitka A. Virag
- Brody School of Medicine, Department of Physiology, East Carolina University, Greenville, North Carolina, United States of America
| | - Robert M. Lust
- Brody School of Medicine, Department of Physiology, East Carolina University, Greenville, North Carolina, United States of America
| | - Stefan Clemens
- Brody School of Medicine, Department of Physiology, East Carolina University, Greenville, North Carolina, United States of America
- * E-mail:
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20
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Abstract
The autonomic nervous system is the primary extrinsic control of cardiac performance, and altered autonomic activity has been recognized as an important factor in the progression of various cardiac pathologies. Molecular imaging techniques have been developed for global and regional interrogation of pre- and postsynaptic targets of the cardiac autonomic nervous system. Building on established work with the guanethidine analogue ¹²³I-metaiodobenzylguanidine (MIBG) for single-photon emission tomography (SPECT), development of radiotracers and protocols for positron emission tomography (PET) investigation of autonomic signaling has expanded. PET is limited in availability and requires specialized centers for radiosynthesis and interpretation, but the higher resolution allows for improved regional analysis and kinetic modeling provides more true quantification than is possible with SPECT. A wider array of radiolabeled catecholamines, analogues of catecholamines, and receptor ligands have been characterized and evaluated. Sympathetic neuronal PET tracers have shown promise in the identification of several cardiac pathologies. In particular, recent studies have elucidated a mechanistic role for heterogeneous sympathetic innervation in the development of lethal ventricular arrhythmias. Evaluation of cardiomyocyte adrenergic receptor expression and the parasympathetic nervous system has been slower to develop, with clinical studies beginning to emerge. This review summarizes the clinical and the experimental PET tracers currently available for autonomic imaging and discusses their application in health and cardiovascular disease, with particular emphasis on the major findings of the last decade.
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Affiliation(s)
- James T Thackeray
- Klinik für Nuklearmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
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21
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Mogensen UM, Jensen T, Køber L, Kelbæk H, Mathiesen AS, Dixen U, Rossing P, Hilsted J, Kofoed KF. Cardiovascular autonomic neuropathy and subclinical cardiovascular disease in normoalbuminuric type 1 diabetic patients. Diabetes 2012; 61:1822-30. [PMID: 22498696 PMCID: PMC3379682 DOI: 10.2337/db11-1235] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 02/23/2012] [Indexed: 12/16/2022]
Abstract
Cardiovascular autonomic neuropathy (CAN) is associated with increased mortality in diabetes. Since CAN often develops in parallel with diabetic nephropathy as a confounder, we aimed to investigate the isolated impact of CAN on cardiovascular disease in normoalbuminuric patients. Fifty-six normoalbuminuric, type 1 diabetic patients were divided into 26 with (+) and 30 without (-) CAN according to tests of their autonomic nerve function. Coronary artery plaque burden and coronary artery calcium score (CACS) were evaluated using computed tomography. Left ventricular function was evaluated using echocardiography. Blood pressure and electrocardiography were recorded through 24 h to evaluate nocturnal drop in blood pressure (dipping) and pulse pressure. In patients +CAN compared with -CAN, the CACS was higher, and only patients +CAN had a CACS >400. A trend toward a higher prevalence of coronary plaques and flow-limiting stenosis in patients +CAN was nonsignificant. In patients +CAN, left ventricular function was decreased in both diastole and systole, nondipping was more prevalent, and pulse pressure was increased compared with -CAN. In multivariable analysis, CAN was independently associated with increased CACS, subclinical left ventricular dysfunction, and increased pulse pressure. In conclusion, CAN in normoalbuminuric type 1 diabetic patients is associated with distinct signs of subclinical cardiovascular disease.
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Affiliation(s)
- Ulrik Madvig Mogensen
- The Heart Centre, Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
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Nugent AC, Bain EE, Thayer JF, Sollers JJ, Drevets WC. Sex differences in the neural correlates of autonomic arousal: a pilot PET study. Int J Psychophysiol 2011; 80:182-91. [PMID: 21414364 DOI: 10.1016/j.ijpsycho.2011.03.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 02/23/2011] [Accepted: 03/01/2011] [Indexed: 12/30/2022]
Abstract
Electrophysiology, behavioral, and neuroimaging studies have revealed sex-related differences in autonomic cardiac control, as reflected in measurements of heart rate variability (HRV). Imaging studies indicate that the neurobiological correlates of autonomic nervous system (ANS) function can be investigated by measuring indices of HRV during the performance of mildly strenuous motor tasks or mildly stressful cognitive tasks. In this preliminary study, fifteen male and seven female healthy subjects underwent H(2)(15)O-positron emission tomography (PET) and electrocardiograph (ECG) recording while performing a handgrip motor task and an n-back task. Indices of HRV were calculated and correlated with regional cerebral blood flow (rCBF). We hypothesized that sex differences would be evident in brain regions known to participate in autonomic regulation: the anterior insula, the anterior cingulate cortex, the orbitofrontal cortex, and the amygdala. Our study found that associations between rCBF and parasympathetic indices differed significantly between female and male subjects in the amygdala. Females showed a positive correlation between rCBF and parasympathetic indices while males exhibited negative correlations. This differential correlation of amygdala rCBF and parasympathetic activity between males and females may reflect differences in parasympathetic/sympathetic balance between sexes, consistent with known sexual dimorphism in the amygdala and closely related structures such as the hypothalamus. These preliminary imaging results are consistent with earlier reports of significant correlation between brain activity and HRV, and extend these findings by demonstrating prominent sex differences in the neural control of the ANS. While the generalizability of our results was limited by the small size of the study samples, the relatively robust effect size of the differences found between groups encourages further work in larger samples to characterize sex differences in the neural correlates of autonomic arousal.
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Affiliation(s)
- Allison C Nugent
- Section on Neuroimaging in Mood and Anxiety Disorders, NIMH/NIH, 9 Memorial Drive, MSC 0940, Bethesda, MD 20892-0940, United States.
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Abstract
Cardiac autonomic function plays a crucial role in health and disease, with abnormalities both reflecting the severity of the disease and contributing specifically to clinical deterioration and poor prognosis. Radiotracer analogs of the sympathetic mediator norepinephrine have been investigated extensively, and are at the brink of potential widespread clinical use. The most widely studied SPECT tracer, I-123 metaiodobenzylguanidine ((123)I-mIBG) has consistently shown a strong, independent ability to risk stratify patients with advanced congestive heart failure. Increased global cardiac uptake appears to have a high negative predictive value in terms of cardiac events, especially death and arrhythmias, and therefore and may have a role in guiding therapy, particularly by helping to better select patients unresponsive to conventional medical therapies who would benefit from device therapies such as an ICD (implantable cardioverter defibrillator), CRT (cardiac resynchronization therapy), LVAD (left ventricular assist device), or cardiac transplantation. Cardiac autonomic imaging with SPECT and PET tracers also shows potential to assess patients following cardiac transplant, those with primary arrhythmic condition, coronary artery disease, diabetes mellitus, and during cardiotoxic chemotherapy. Radiotracer imaging of cardiac autonomic function allows visualization and quantitative measurements of underlying molecular aspects of cardiac disease, and should therefore provide a perspective that other cardiac tests cannot.
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Affiliation(s)
- Sang Yong Ji
- Department of Nuclear Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East-210th Street, Bronx, NY 10467-2490, USA
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Maser RE, Stabley JN, Lenhard MJ, Provost-Craig MA. Autonomic nerve fiber function and bone mineral density in individuals with type 1 diabetes: a cross-sectional study. Diabetes Res Clin Pract 2009; 84:252-8. [PMID: 19282045 DOI: 10.1016/j.diabres.2009.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 11/11/2008] [Accepted: 02/09/2009] [Indexed: 11/23/2022]
Abstract
AIMS Experimental models support a role for the sympathetic nervous system in bone metabolism. Beta-adrenoreceptors have been demonstrated on osteoblast-like cells. Beta-blocker use is associated with higher bone mineral density (BMD) in some epidemiologic studies. The aim of this study was to determine if measures of the autonomic nervous system (ANS) were associated with reduced BMD in type 1 diabetes. METHODS We studied 66 individuals with type 1 diabetes. Dual-energy X-ray absorptiometry was used to measure BMD and bone mineral content (BMC). Measures of heart rate variability (HRV) (e.g., power spectral analysis, mean circular resultant) and circulating norepinephrine levels were used to evaluate autonomic function. RESULTS BMD/BMC were examined by gender for individuals with a normal versus elevated low-frequency (LF) band (expressed in normalized units). No significant differences in BMD/BMC were shown for individuals with an elevated LF band. Direct-entry linear regression models with BMD/BMC as the dependent variable were performed. Duration, gender, BMI, HbA(1c), insulin dose/kg, activity energy expenditure, and measures of HRV were entered as potential independent variables. No measures of HRV, or norepinephrine, were independently associated with BMD/BMC. CONCLUSIONS The ANS, as assessed by measures of HRV, does not appear to impact BMD/BMC in type 1 diabetes.
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Affiliation(s)
- Raelene E Maser
- Department of Medical Technology, University of Delaware, Newark, DE 19716, United States.
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Aydin Kaderli A, Güllülü S, Ozdemir B, Sentürk T, Aydinlar A. The relationship between cardiac autonomic neuropathy and Tei index in patients with type II diabetes mellitus. Acta Cardiol 2008; 63:629-33. [PMID: 19014008 DOI: 10.2143/ac.63.5.2033232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We have investigated the relationship between silent cardiac autonomic neuropathy (CAN), one of the most important causes of mortality in diabetic patients, and the Tei index, which is an indicator of global ventricular function. METHODS Among the patients with type 2 diabetes mellitus, 15 without autonomic neuropathy (Ewing score < 1) were accepted as CAN (-) and 18 with autonomic neuropathy (Ewing score > or =1) were accepted as CAN (+).Twelve healthy individuals were included in the control group. Diastolic dysfunction and Tei index were evaluated by means of 2-D and Doppler echocardiographic examination. RESULTS Not only Doppler mitral, but also tricuspid inflow parameters showed a significant decrease in E/A ratio, an increase in A wave amplitude and deceleration time with CAN (+) patients. Left ventricular Tei index and Ewing score were found to be positively correlated (P < 0.001, r = 0.55). Likewise to the correlation in the left ventricle, a positive correlation was also detected between right ventricular Tei index and Ewing score (P = 0.004, r = 0.43). CONCLUSIONS We have shown that in patients with type II diabetes, CAN is related with left and right ventricular diastolic dysfunction.We also have determined that the Tei index is in correlation with CAN (Ewing score), which is a complication of diabetes.
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Affiliation(s)
- Aysel Aydin Kaderli
- Uludag University Faculty of Medicine, Department of Cardiology, 16059 Gorukle, Bursa, Turkey.
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Owen SLF, Green AL, Davies P, Stein JF, Aziz TZ, Behrens T, Voets NL, Johansen-Berg H. Connectivity of an effective hypothalamic surgical target for cluster headache. J Clin Neurosci 2007; 14:955-60. [PMID: 17689083 DOI: 10.1016/j.jocn.2006.07.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 07/06/2006] [Accepted: 07/14/2006] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to look at the connectivity of the posterior inferior hypothalamus in a patient implanted with a deep brain stimulating electrode using probabilistic tractography in conjunction with postoperative MRI scans. In a patient with chronic cluster headache we implanted a deep brain stimulating electrode into the ipsilateral postero-medial hypothalamus to successfully control his pain. To explore the connectivity, we used the surgical target from the postoperative MRI scan as a seed for probabilistic tractography, which was then linked to diffusion weighted imaging data acquired in a group of healthy control subjects. We found highly consistent connections with the reticular nucleus and cerebellum. In some subjects, connections were also seen with the parietal cortices, and the inferior medial frontal gyrus. Our results illustrate important anatomical connections that may explain the functional changes associated with cluster headaches and elucidate possible mechanisms responsible for triggering attacks.
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Affiliation(s)
- S L F Owen
- University Laboratory of Physiology, University of Oxford, Oxford, UK
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Stegger L, Schäfers K, Kopka K, Wagner S, Hermann S, Kies P, Law M, Schober O, Schäfers M. Molecular cardiovascular imaging using scintigraphic methods. Eur Radiol 2007; 17:1422-32. [PMID: 17206422 DOI: 10.1007/s00330-006-0541-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 11/02/2006] [Accepted: 11/24/2006] [Indexed: 10/23/2022]
Abstract
Molecular cardiovascular imaging plays an increasingly important role both in basic research and in clinical diagnosis. Scintigraphic methods have long been used to study pathophysiological changes on a cellular and molecular level, and they are likely to remain important molecular imaging modalities in the foreseeable future. This article provides an overview over current developments in cardiovascular molecular imaging using scintigraphic methods. The focus lies on imaging of cardiac innervation, plaque instability, hypoxia and angiogenesis, gene expression and stem and progenitor cell migration and proliferation.
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Affiliation(s)
- Lars Stegger
- Department of Nuclear Medicine, University Hospital of Münster, Albert-Schweitzer-Str. 33, 48149 Münster, Germany.
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Yeh TL, Yang YK, Chiu NT, Yao WJ, Yeh SJ, Wu JS, Chuang JI, Chang SH. Correlation between striatal dopamine D2/D3 receptor binding and cardiovascular activity in healthy subjects. Am J Hypertens 2006; 19:964-9. [PMID: 16942941 DOI: 10.1016/j.amjhyper.2006.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Revised: 03/01/2006] [Accepted: 03/09/2006] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The relationship between the striatal dopaminergic system and cardiovascular activity is not well known. The aim of this study is to investigate the relationship between striatal D2/D3 receptor binding and cardiovascular activity. METHODS The striatal D2/D3 receptor binding of 34 healthy volunteers was assessed by the single-photon emission computed tomography (SPECT) imaging method with the [123I]-iodobenzoamide (IBZM) ligand. The ratio of the radioactivity in the striatum (St) and the frontal cortex (Fc) (St/Fc ratio) was used as the marker for striatal D2/D3 receptor binding. Their cardiac autonomic functions were measured by continuously monitoring their heart rate and blood pressure (BP) in supine position during 10 min. The heart rate variability (HRV) was analyzed by spectral analysis and the geometric method. RESULTS The St/Fc ratio of striatal dopamine D2/D3 receptor binding correlated negatively with heart rate (HR), and positively with cardiac vagal index (CVI) and low frequency (LF) power in healthy subjects who were in a supine resting position. CONCLUSIONS Striatal dopamine D2/D3 receptors may play a part in cardiovascular regulation.
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Affiliation(s)
- Tzung-Lieh Yeh
- Department of Psychiatry, National Cheng Kung University Medical Center, and Department of Neurology, Cheng Ching Hospital, Tainan, Taiwan
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Abstract
AIMS To detect impairment in short-term heart rate variability (HRV) in children after heart and heart-lung transplantation (TX) as reported in adults. To assess vagal and sympathetic influence on the donor heart rate using frequency domain analysis of HRV. METHODS AND RESULTS Measurement of short-term HRV was performed in 17 patients (age 16.9+/-3.6, 6.1+/-3.7 yr after TX) and 12 healthy controls (age 14.8+/-3.0 yr). Testing consisted of a resting phase of 15 minutes followed by a tilt phase of 45 min. All HRV parameters were significantly impaired in transplanted patients: RR interval (RRI) 717.2+/-122.5 m/s (controls 827+/-139.7, p<0.05), standard deviation of RR interval (RRI-SD) 20.1+/-15.5 (89.9+/-38.4, p<0.001), RRI at tilt 607.9+/-79.7 (654.0+/-104.7, NS), RRI-SD at tilt 21.1+/-20.0 (60.4+/-31.4, p<0.001). Low-frequency (LF)/High-frequency (HF) ratio of HRV showed prominent sympathetic influence in TX-patients (3.38+/-5.60 vs. 1.18+/-0.86, NS) increasing during tilting (5.91+/-8.36 vs. 4.74+/-5.27, NS). In subgroup analysis, 4 yr after TX an increasing sympathetic control of heart rate was observed. CONCLUSION Short-term HRV is severely impaired in children after TX. If changes are observed, they are time-related and show increasing sympathetic influence starting from 4 yr after TX.
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Affiliation(s)
- Robert Dalla Pozza
- Department of Pediatric Cardiology, Ludwig Maximilians University, Munich, Germany.
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Abstract
OBJECTIVES To determine whether Parkinson's disease (PD) can be distinguished from multiple system atrophy (MSA) on the basis of the assessment of iodine-123 meta-iodobenzylguanidine (123I-MIBG) radioactivity in heart and cardiovascular autonomic function. PATIENTS AND METHODS Seventeen patients with MSA, 39 with PD, and 25 healthy volunteers underwent 123I-MIBG scintigraphy and hemodynamic autonomic function tests using Valsalva maneuver (VM). Baroreceptor reflex sensitivity (BRS) was measured using the slope of the relation between RR interval and blood pressure during the fourth phase. RESULTS 123I-MIBG radioactivity in heart of patients with PD was lower than that of control subjects and patients with MSA, but there was some overlap between PD and MSA. BRS in patients with PD who had a 123I-MIBG radioactivity similar to that in MSA was larger than that in patients with MSA, with no overlap in any patient. CONCLUSION Assessment of BRS may be useful for differentiating between MSA and PD that had a 123I-MIBG radioactivity similar to MSA.
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Affiliation(s)
- H Oka
- Department of Neurology, Aoto Hospital, Tokyo, Japan.
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Mehlsen J. [Examinations of the autonomic nervous system. The Danish Society of Clinical Physiology and Nuclear Medicine]. Ugeskr Laeger 2006; 168:1227. [PMID: 16571318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Jesper Mehlsen
- Klinisk Fysiologisk/nuklearmedicinsk Afdeling, H:S Frederiksberg Hospital, DK-2000 Frederiksberg.
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Tipre DN, Goldstein DS. Cardiac and extracardiac sympathetic denervation in Parkinson's disease with orthostatic hypotension and in pure autonomic failure. J Nucl Med 2005; 46:1775-81. [PMID: 16269589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
UNLABELLED The uptake of 6-(18)F-fluorodopamine by cardiac noradrenergic nerves enables visualization of the sympathetic innervation of the left ventricular myocardium by PET. Patients with Parkinson's disease (PD) and orthostatic hypotension (OH) (PD+OH) or with pure autonomic failure (PAF) have markedly decreased myocardial 6-(18)F-fluorodopamine-derived radioactivity, consistent with cardiac sympathetic denervation, a phenomenon that neurochemical, neuropharmacologic, and, most recently, postmortem neuropathologic studies have confirmed. In this study, we examined whether 6-(18)F-fluorodopamine can visualize sympathetic innervation in extracardiac organs and, if so, whether patients with PD+OH or PAF have neuroimaging evidence of extracardiac noradrenergic denervation. METHODS To validate the method, healthy volunteers underwent 6-(18)F-fluorodopamine scanning of the head, thorax, and abdomen, with or without treatment with desipramine to block sympathoneural uptake of catecholamines. (13)N-Ammonia scanning was used to address possible group differences in 6-(18)F-fluorodopamine delivery by blood perfusion. RESULTS Desipramine treatment was associated with decreased 6-(18)F-fluorodopamine-derived radioactivity in the heart, renal cortex, and thyroid gland but not in the liver, spleen, renal pelvis, or salivary glands. Both the PD+OH group and the PAF group had decreased 6-(18)F-fluorodopamine-derived radioactivity in the heart (P < 0.0001) and renal cortex (P = 0.02 and P = 0.005, respectively). The PD+OH group also had decreased radioactivity in the thyroid gland (P = 0.01). Neither group had decreased radioactivity in the other organs, after correction for (13)N-ammonia-derived radioactivity. CONCLUSION 6-(18)F-Fluorodopamine scanning visualizes sympathetic innervation in the heart, renal cortex, and thyroid gland. Both PD+OH and PAF involve decreased noradrenergic innervation that is most prominent in the heart but is also detectable in extracardiac organs.
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Affiliation(s)
- Dnyanesh N Tipre
- Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Woo MA, Macey PM, Keens PT, Kumar R, Fonarow GC, Hamilton MA, Harper RM. Functional Abnormalities in Brain Areas That Mediate Autonomic Nervous System Control in Advanced Heart Failure. J Card Fail 2005; 11:437-46. [PMID: 16105635 DOI: 10.1016/j.cardfail.2005.02.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Revised: 02/04/2005] [Accepted: 02/07/2005] [Indexed: 12/30/2022]
Abstract
BACKGROUND Heart failure patients show substantial gray matter loss in brain areas that mediate autonomic control. Those injuries may lead to the aberrant autonomic patterns found in the syndrome. The purpose of this study was to determine if functional responses in the brain to an autonomic challenge would differ from normal patterns and would appear in areas of previously-demonstrated gray matter loss. METHODS AND RESULTS We subjected 6 heart failure patients (left ventricular ejection fraction 0.15 +/- 0.08; age 49 +/- 12 years) and 16 controls (age 48 +/- 11 years) to a forehead cold pressor challenge that would enhance sympathetic outflow and assessed functional magnetic resonance image signals over the entire brain during a 54-second baseline and 90-second challenge. Application of the cold stimulus elicited aberrant responses in the anterior and posterior hypothalamus, bilateral amygdala, hippocampus, cerebellar cortex, insular cortex, mid/posterior cingulate cortex, right ventral frontal cortex, and temporal and frontal cortices. Many of the areas neighbored or overlaid regions of previously demonstrated gray matter damage. Both classical autonomic control regions, as well as brain areas modulating these sites showed deficient responses, some of which appeared to be of an overdampened or underdampened nature. CONCLUSION The findings suggest that the earlier demonstrated changes in brain structure in heart failure result in aberrant functional neural responses; these dysfunctions may contribute to progression of the pathology in heart failure.
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Affiliation(s)
- Mary A Woo
- School of Nursing, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 90095, USA
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Taki J, Yoshita M, Yamada M, Tonami N. Significance of 123I-MIBG scintigraphy as a pathophysiological indicator in the assessment of Parkinson's disease and related disorders: it can be a specific marker for Lewy body disease. Ann Nucl Med 2005; 18:453-61. [PMID: 15515743 DOI: 10.1007/bf02984560] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Recently, reliable and clear evidence for the usefulness of 123I-MIBG scintigraphy in the diagnosis of Parkinson's disease (PD) has been accumulated and it has become increasingly popular as one of the most accurate means of diagnosing the disease. PD, one of the most common neurodegenerative disorders, is characterized by resting tremor, rigidity, bradykinesia or akinesia, and postural instability. The disease is characterized pathologically by distinctive neuronal inclusions called Lewy bodies in many surviving cells of dopaminergic neurons of the substantia nigra pars compacta and other specific brain regions. Furthermore Lewy body type degeneration in the cardiac plexus has been observed in PD. In PD, cardiac MIBG uptake is reduced markedly even in the early disease stages; therefore, MIBG imaging can be used as an indicator of the presence of PD rather than disease severity. Other parkinsonian syndromes such as multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration demonstrate normal cardiac MIBG uptake or only mild reduction of MIBG uptake, indicating that MIBG imaging is a powerful method to differentiate PD from other parkinsonian syndromes. Dementia with Lewy bodies (DLB) also shows severe reduction of MIBG uptake, whereas Alzheimer's disease (AD) demonstrates normal MIBG uptake, permitting differentiation of DLB from AD using MIBG scintigraphy. In pure autonomic failure, which shares similar pathological findings with PD and is thought to be associated with diffuse loss of sympathetic terminal innervation, cardiac MIBG uptake also decreases markedly. Considering all the data together, marked reduction of cardiac MIBG uptake seems to be a specific marker of Lewy body disease and thus extremely useful in the differentiation from other diseases with similar symptoms without Lewy bodies.
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Affiliation(s)
- Junichi Taki
- Department of Biotracer Medicine, Kanazawa University Graduate School of Medical Sciences, Japan.
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Knuuti J, Sipola P. Is it time for cardiac innervation imaging? Q J Nucl Med Mol Imaging 2005; 49:97-105. [PMID: 15724139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The autonomic nervous system plays an important role in the regulation of cardiac function and the regional distribution of cardiac nerve terminals can be visualized using scintigraphic techniques. The most commonly used tracer is iodine-123-metaiodobenzylguanidine (MIBG) but C-11-hydroxyephedrine has also been used with PET. When imaging with MIBG, the ratio of heart-to-mediastinal counts is used as an index of tracer uptake, and regional distribution is also assessed from tomographic images. The rate of clearance of the tracer can also be measured and indicates the function of the adrenergic system. Innervation imaging has been applied in patients with susceptibility to arrhythmias, coronary artery disease, hypertrophic and dilated cardiomyopathy and anthracycline induced cardiotoxicity. Abnormal adrenergic innervation or function appear to exist in many pathophysiological conditions indicating that sympathetic neurons are very susceptible to damage. Abnormal findings in innervation imaging also appear to have significant prognostic value especially in patients with cardiomyopathy. Recently, it has also been shown that innervation imaging can monitor drug-induced changes in cardiac adrenergic activity. Although innervation imaging holds great promise for clinical use, the method has not received wider clinical acceptance. Larger randomized studies are required to confirm the value of innervation imaging in various specific indications.
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Affiliation(s)
- J Knuuti
- Turku PET Centre, PO Box 52, University of Turku, FI-20521 Turku, Finland.
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Takahashi N, Nakagawa M, Saikawa T, Watanabe M, Ooie T, Yufu K, Shigematsu S, Hara M, Sakino H, Katsuragi I, Tanaka K, Yoshimatsu H. Regulation of QT indices mediated by autonomic nervous function in patients with type 2 diabetes. Int J Cardiol 2004; 96:375-9. [PMID: 15301890 DOI: 10.1016/j.ijcard.2003.07.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2003] [Revised: 06/28/2003] [Accepted: 07/25/2003] [Indexed: 11/29/2022]
Abstract
Both the QT interval and QT dispersion in diabetic patients have been reported to increase with the progression of cardiac autonomic neuropathy and to have a prognostic value. We assessed the cardiac autonomic influences on QT indices using the measurements of baroreflex sensitivity, heart rate variability, and cardiac (123)I-metaiodobenzylguanidine scintigraphic findings in patients with type 2 diabetes mellitus. Forty-two consecutive patients with type 2 diabetes (mean+/-SD: 54+/-10 years, 22 women and 20 men) were studied. Baroreflex sensitivity negatively correlated with the maximum and minimum QTc intervals as well as QT/QTc dispersion. However, the high-frequency power and the ratio of low-frequency power to high-frequency power of heart rate variability did not correlate with any QT indices. The percent washout rate of (123)I-metaiodobenzylguanidine positively correlated with QT/QTc dispersion, but not with maximum and minimum QTc intervals. Our findings suggest that cardiac vagal dysfunction is related to QT interval prolongation while both sympathetic and vagal dysfunctions are related to increased QT dispersion in type 2 diabetic patients. Baroreflex sensitivity and percent washout rate of (123)I-metaiodobenzylguanidine may be useful parameters indicating the abnormalities of the cardiac ventricular repolarization in this population.
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Affiliation(s)
- Naohiko Takahashi
- Department of Internal Medicine I, School of Medicine, Oita Medical University, 1-1 Idaigaoka, Hasama, Oita 879-5593, Japan.
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James TN. Combinatorial roles of the human intertruncal plexus in mediating both afferent and efferent autonomic neural traffic and in producing a cardiogenic hypertensive chemoreflex. Prog Cardiovasc Dis 2004; 46:539-72. [PMID: 15224259 DOI: 10.1016/j.pcad.2004.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas N James
- Department of Medicine, University of Texas Medical Branch, Galveston, 77555-0175, USA.
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Teves D, Videen TO, Cryer PE, Powers WJ. Activation of human medial prefrontal cortex during autonomic responses to hypoglycemia. Proc Natl Acad Sci U S A 2004; 101:6217-21. [PMID: 15026569 PMCID: PMC395949 DOI: 10.1073/pnas.0307048101] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2003] [Accepted: 02/05/2004] [Indexed: 12/30/2022] Open
Abstract
Studies in humans implicate the medial prefrontal cortex (MPFC) in complex cognitive and emotional states. We measured regional cerebral blood flow (CBF) four times each during euglycemia (5.2 +/- 0.2 mmol/liter) and hypoglycemia (3.0 +/- 0.3 mmol/liter) in nine normal human volunteers. Autonomic responses during hypoglycemia were manifested by increases in neurogenic symptoms, heart rate, and plasma levels of epinephrine, norepinephrine, and pancreatic polypeptide. Typical symptoms of hypoglycemia were mild, and none reflected evidence of cognitive or emotional stress. Quantitative CBF fell 6-8% in the cerebrum, brainstem, and cerebellum. Analysis of regional CBF differences identified neuronal activation during hypoglycemia in bilateral MPFC (areas 24 and 32) and bilateral thalamus. These results provide evidence that the MPFC participates in the autonomic responses to simple physiological stimuli in humans.
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Affiliation(s)
- Denise Teves
- Division of Endocrinology, Metabolism, and Lipid Research of the Department of Internal Medicine, Washington University School of Medicine, Campus Box 8127, 660 South Euclid Avenue, St. Louis, MO 63110, USA
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Clark PB, Gage HD, Brown-Proctor C, Buchheimer N, Calles-Escandon J, Mach RH, Morton KA. Neurofunctional imaging of the pancreas utilizing the cholinergic PET radioligand [ 18 F]4-fluorobenzyltrozamicol. Eur J Nucl Med Mol Imaging 2004; 31:258-60. [PMID: 15129709 DOI: 10.1007/s00259-003-1350-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The pancreas is one of the most heavily innervated peripheral organs in the body. Parasympathetic and sympathetic neurons terminate in the pancreas and provide tight control of endocrine and exocrine functions. The aim of this study was to determine whether the pancreas can be imaged with a radioligand that binds to specific neuroreceptors. Using fluorine-18 4-fluorobenzyltrozamicol (FBT), which binds to the presynaptic vesicular acetylcholine transporter, positron emission tomography scans were performed in four adult mice, two adult rhesus monkeys, and one adult human. In these mammals, the pancreas is intensely FBT avid, with uptake greater than in any other organ at 30, 60, and 90 min. The maximum standardized uptake value (SUV) ratios of pancreas to liver, for example, ranged from 1.4 to 1.7 in rhesus monkeys (mean 1.6; median 1.7) and from 1.9 to 4.7 (mean 3.24; median 3.02) in mice. The maximum SUV ratio of pancreas to liver in the human was 1.8. These data suggest that neuroreceptor imaging of the pancreas in vivo is feasible in animal models and humans. This imaging could allow researchers to interrogate functions under control of the autonomic nervous system in the pancreas, with applications possible in transplanted and native pancreata. Also, as beta cell function is intimately related to parasympathetic cholinergic input, FBT activity in the pancreas may correlate with insulin-producing beta cell mass. This could ultimately provide a method of in vivo imaging in animal models and humans for diabetes research.
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Affiliation(s)
- P B Clark
- Nuclear Medicine Section, Department of Radiology, Wake Forest University School of Medicine, Winston-Salem 27157, USA.
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Abstract
The authors report results of SPECT cerebral perfusion studies in two patients with familial dysautonomia (FD) during dysautonomic crises and when clinically stable. SPECT imaging studies used 99mTc ethylene cysteine dimer. During dysautonomic crises, regions in the temporoparietal and frontal lobes had increased uptake. Uptake in these areas was less during asymptomatic periods. Episodic asymmetric cerebral perfusion during crises especially affecting the frontal and temporal lobes is suggestive of ictal activity.
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Affiliation(s)
- F B Axelrod
- Department of Pediatrics, New York University School of Medicine, NY 10016, USA
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Affiliation(s)
- P G Camici
- MRC Cyclotron Unit, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
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Braune S, Reinhardt M, Schnitzer R, Riedel A, Lücking CH. Cardiac uptake of [123I]MIBG separates Parkinson's disease from multiple system atrophy. Neurology 1999; 53:1020-5. [PMID: 10496261 DOI: 10.1212/wnl.53.5.1020] [Citation(s) in RCA: 214] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To improve the differential diagnosis between patients with multiple system atrophy (MSA) and idiopathic PD (IPD) with autonomic failure. BACKGROUND Some patients diagnosed with IPD are discovered to have alternative diseases such as MSA, despite the application of stringent diagnostic criteria. This differentiation is particularly difficult if patients with IPD also show symptoms of autonomic failure. In IPD, autonomic failure is caused by damage of the postganglionic part of the autonomic nervous system, whereas in MSA, degeneration of preganglionic and central autonomic neurons is revealed histopathologically. METHODS Scintigraphy with [123I]metaiodobenzylguanidine (MIBG) enables the quantification of postganglionic sympathetic cardiac innervation. Fifteen patients with IPD and 5 patients with MSA underwent standard autonomic function tests and scintigraphy with MIBG. RESULTS In all patients, cardiovascular testing showed evidence of autonomic failure of varying severity. In all patients with IPD, the heart-mediastinum (H/M) ratio of MIBG uptake was pathologically impaired, independent of duration and severity of autonomic and parkinsonian symptoms. All patients with MSA had a regular H/M ratio. Each patient could be assigned to the correct diagnostic group based on the results of the MIBG scintigraphy, even if the duration of the disease was only 2 years or less. CONCLUSIONS This population assessment of the heart-mediastinum ratio of [123I]metaiodobenzylguanidine uptake showed a high sensitivity for the detection of autonomic involvement in patients with idiopathic IPD and also a high specificity for the discrimination between idiopathic PD and MSA.
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Affiliation(s)
- S Braune
- Neurologische, Universitätsklinik Freiburg, Germany
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Bornmyr S, Castenfors J, Svensson H, Wroblewski M, Sundkvist G, Wollmer P. Detection of autonomic sympathetic dysfunction in diabetic patients. A study using laser Doppler imaging. Diabetes Care 1999; 22:593-7. [PMID: 10189537 DOI: 10.2337/diacare.22.4.593] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study signs of the disturbed reflex autonomic sympathetic nerve function in type 1 and type 2 diabetic patients. RESEARCH DESIGN AND METHODS Measurements were made on 15 type 1 (duration 13-32 years) and on 50 recently diagnosed type 2 diabetic patients (duration 3-4 years). The vasoconstrictor responses in the distal phalanx of the middle finger (locally heated to 40 degrees C) to the cooling of the contralateral arm were measured using Laser Doppler Imaging (LDI). A vasoconstriction index (VAC) was calculated taking age into account and was compared with reference values obtained in 80 control subjects. The diabetic patients were also studied with deep-breathing tests (i.e., the heart-rate variation expressed as the expiration-to-inspiration [E/I] ratio, a test of parasympathetic nerve function). RESULTS The vasoconstrictor responses to indirect cooling (VAC) were significantly reduced in the fingers of the diabetic patients, both type 2 (0.77 +/- 0.02 V; P < 0.01) and type 1 (0.83 +/- 0.04 V; P < 0.001), compared with the healthy control subjects (0.65 +/- 0.01); the age-corrected VAC (VACz) was slightly more impaired in type 1 than in type 2 diabetic patients. The frequency of an abnormal VACz corresponded well to the frequency of an abnormal E/I ratio in type 1 diabetic patients (approximately 50%), whereas the frequency of an abnormal VACz was significantly higher than an abnormal E/I ratio among type 2 diabetic patients (11/50 vs. 4/50; P < 0.05). CONCLUSIONS Both type 1 and type 2 diabetic patients have impaired cutaneous blood flow regulation. The VAC index seems to be a promising tool for detection of subclinical changes in autonomic sympathetic function.
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Affiliation(s)
- S Bornmyr
- Department of Clinical Physiology, Malmo University Hospital, Sweden.
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Abstract
PURPOSE Patients with idiopathic orthostatic intolerance often have debilitating symptoms on standing that are suggestive of cerebral hypoperfusion despite the absence of orthostatic hypotension. SUBJECTS AND METHODS We evaluated the effects of graded head-up tilt on cerebral blood flow as determined by transcranial Doppler measurements in 10 patients with idiopathic orthostatic intolerance (nine women, one man, 22 to 47 years) and nine age- and sex-matched control subjects. RESULTS In patients, mean (+/- SD) arterial pressure at 0 degrees head-up tilt was 90 +/- 11 mm Hg and was well maintained at all tilt angles (90 +/- 11 mm Hg at 75 degrees). In controls, mean arterial pressure was 85 +/- 7 mm Hg at 0 degrees and 82 +/- 11 mm Hg at 75 degrees head-up tilt. There was a substantial decrease in peak velocity with increasing tilt angle in patients (28% +/- 10%) but not in controls (10% +/- 10% at 75 degrees, P <0.001). Similarly, mean velocity decreased 26% +/- 13% in patients and 12% +/- 11% in controls (P = 0.01). With increasing head-up tilt, patients had a significantly greater increase in regional cerebrovascular resistance than controls. CONCLUSIONS In patients with idiopathic orthostatic intolerance, peak and mean middle cerebral artery blood flow velocity decreased in response to head-up tilt despite well sustained arterial blood pressure. These observations indicate that in this group of patients, regulation of cerebrovascular tone may be impaired and might therefore be a target for therapeutic interventions.
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Affiliation(s)
- G Jacob
- Recanati Autonomic Dysfunction Center, Haifa, Israel
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Abstract
Nuclear imaging techniques are well established diagnostic tools in clinical cardiology, providing noninvasive information about myocardial perfusion, function and metabolism. The cost-effectiveness of radionuclide imaging in the diagnostic work-up of patients with coronary artery disease has been demonstrated. Additionally, the documented prognostic value of scintigraphic parameters is of clinical importance to guide decision making. Advances in technology, new radiotracers and new applications contribute to continuous growth in the field of nuclear cardiology. Multi-headed gamma camera systems lead to higher spatial resolution and sensitivity of cardiac single photon emission tomography (SPECT), and they also provide the opportunity for attenuation correction or electrocardiographic gating of SPECT images. Objective quantitative values of perfusion, function and metabolism are derived from scintigraphic data by use of improved software and hardware. With the latest developments in tracer technology, imaging of myocardial necrosis, receptor systems and autonomic innervation has become a reality and will lead to new clinical applications in the future.
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Affiliation(s)
- F M Bengel
- Nuklearmedizinische Klinik und Poliklinik, Technischen Universität München, Munich, Germany
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Machida K, Honda N, Mamiya T, Takahashi T, Kamano T, Kashimada A, Inoue Y, Kinoshita M. Abnormal sympathetic innervation of the heart in a patient with myotonic dystrophy detected with I-123 MIBG cardiac SPECT. Clin Nucl Med 1994; 19:968-72. [PMID: 7842590 DOI: 10.1097/00003072-199411000-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Iodine-123 MIBG is a norepinephrine analog which can be used to image the sympathetic innervation of the heart. The authors report a patient with myotonic dystrophy whose I-123 MIBG SPECT revealed accelerated washout of I-123 MIBG from infero-posterior and a part of lateral wall, although Tl-201 SPECT showed no abnormal finding. The authors conclude that I-123 MIBG can be more sensitive in detecting the cardiac abnormality than Tl-201 SPECT in this disease.
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Affiliation(s)
- K Machida
- Department of Radiology, Saitama Medical Center, Saitama Medical School, Japan
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Abstract
Positron emission tomography (PET) allows, in combination with multiple radiopharmaceuticals, unique physiological and biochemical tissue characterization. Tracers of blood flow, metabolism and neuronal function have been employed with this technique for research application. More recently, PET has emerged in cardiology as a useful tool for the detection of coronary artery disease and the evaluation of tissue viability. Metabolic tracers such as fluorine-18 deoxyglucose (FDG) permit the specific delineation of ischaemically compromised myocardium. Clinical studies have indicated that the metabolic imaging is helpful in selecting patients for coronary artery bypass surgery or coronary angioplasty. More recent research work has concentrated on the use of carbon-11 acetate as a marker of myocardial oxygen consumption. Together with measurements of left ventricular performance, estimates of cardiac efficiency can be derived from dynamic 11C-acetate studies. The non-invasive evaluation of the autonomic nervous system of the heart was limited in the past. With the introduction of radiopharmaceuticals which specifically bind to neuronal structures, the regional integrity of the autonomic nervous system of the heart can be evaluated with PET. Numerous tracers for pre- and postsynaptic binding sites have been synthesized. 11C-hydroxyephedrine represents a new catecholamine analogue which is stored in cardiac presynaptic sympathetic nerve terminals. Initial clinical studies with it suggest a promising role for PET in the study of the sympathetic nervous system in various cardiac diseases such as cardiomyopathy, ischaemic heart disease and diabetes mellitus. The specificity of the radio-pharmaceuticals and the quantitative measurements of tissue tracer distribution provided by PET make this technology a very attractive research tool in the cardiovascular sciences with great promise in the area of cardiac metabolism and neurocardiology.
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Affiliation(s)
- P Mélon
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0028
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Brooks DJ, Salmon EP, Mathias CJ, Quinn N, Leenders KL, Bannister R, Marsden CD, Frackowiak RS. The relationship between locomotor disability, autonomic dysfunction, and the integrity of the striatal dopaminergic system in patients with multiple system atrophy, pure autonomic failure, and Parkinson's disease, studied with PET. Brain 1990; 113 ( Pt 5):1539-52. [PMID: 2123119 DOI: 10.1093/brain/113.5.1539] [Citation(s) in RCA: 165] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
18F-dopa and S-11C-nomifensine (NMF) are positron emitting tracers whose caudate and putamen uptake reflects striatal dopamine storage capacity and the integrity of dopamine reuptake sites, respectively. Using these two tracers, the integrity of the presynaptic striatal dopaminergic system has been studied with positron emission tomography (PET) in 10 subjects with multiple system atrophy (MSA, Shy-Drager syndrome) who had an akinetic-rigid syndrome that was poorly responsive to L-dopa, autonomic failure, and cerebellar ataxia. PET findings for the 10 MSA patients were compared with those for 13 age-matched controls, 8 subjects with L-dopa responsive Parkinson's disease (PD), and 7 subjects with pure autonomic failure (PAF). Influx constants, Ki, reflecting specific 18F-dopa uptake into striatal tissue, were severely reduced in the putamen and caudate of the 10 MSA subjects (mean putamen Ki 0.005 min-1 MSA vs 0.013 min-1 controls; mean caudate Ki 0.007 min-1 MSA vs 0.013 min-1 controls). Reduction of putamen, but not caudate, 18F-dopa uptake correlated with severity and duration of locomotor disability. Eight patients with PD, and a similar degree and duration of locomotor disability to the patients with MSA, demonstrated equal impairment of mean putamen 18F-dopa uptake, but significant preservation of mean caudate function. The 7 PAF patients had normal mean levels of putamen and caudate 18F-dopa uptake, although 1 individual PAF patient had significantly impaired striatal function. The MSA and PD groups of subjects both showed significantly reduced levels of specific striatal S-11C-NMF binding, again caudate function being relatively preserved in PD. It is concluded that in both MSA and PD there is a parallel decline of striatal dopamine storage capacity and reuptake site integrity, probably reflecting a loss of nigrostriatal nerve terminals. Caudate function is relatively preserved in PD compared with MSA. The majority of PAF patients have an intact nigrostriatal dopaminergic system, suggesting that PAF is a condition distinct from PD and MSA in spite of some pathological similarities. PET is capable of detecting subclinical nigrostriatal involvement in PAF patients when this is present.
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Affiliation(s)
- D J Brooks
- MRC Cyclotron Unit, Hammersmith Hospital, London, UK
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