Abstract | BACKGROUND: In Parkinson disease, orthostatic hypotension can result from L-dopa treatment or from sympathetic neurocirculatory failure. The latter is detected by abnormal blood pressure responses to the Valsalva maneuver and can be associated with loss of functional cardiac sympathetic nerve terminals. OBJECTIVE: DESIGN: Intergroup comparisons in resting patients. SETTING: National Institutes of Health Clinical Center, Bethesda, Maryland. PATIENTS: MEASUREMENTS: Beat-to-beat blood pressure responses to the Valsalva maneuver, interventricular septal 6-[18F]fluorodopamine-derived radioactivity, cardiac extraction fraction of [3H] norepinephrine, appearance rate of norepinephrine in coronary sinus plasma (cardiac norepinephrine spillover) and venous-arterial differences in levels of dihydroxyphenylglycol ( DHPG) and endogenous L-dopa. RESULTS: Of the 29 patients with Parkinson disease, 9 with sympathetic neurocirculatory failure and 11 without had low septal 6-[18F]fluorodopamine-derived radioactivity (2861 +/- 453 Bq/mL per MBq/kg and 5217 +/- 525 Bq/mL per MBq/kg, respectively). All 6 patients with Parkinson disease and decreased 6-[18F]fluorodopamine-derived radioactivity who underwent right-heart catheterization had a decreased cardiac extraction fraction of [3H] norepinephrine and virtually no cardiac norepinephrine spillover or venous-arterial increments in plasma levels of DHPG and L-dopa. Sympathetic neurocirculatory failure and decreased 6-[18F]fluorodopamine-derived radioactivity were unrelated to disease duration, disease severity, or L-dopa treatment CONCLUSIONS:
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Authors | D S Goldstein, C Holmes, S T Li, S Bruce, L V Metman, R O Cannon 3rd |
Journal | Annals of internal medicine
(Ann Intern Med)
Vol. 133
Issue 5
Pg. 338-47
(Sep 05 2000)
ISSN: 0003-4819 [Print] United States |
PMID | 10979878
(Publication Type: Comparative Study, Journal Article)
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Chemical References |
- Fluorine Radioisotopes
- Radiopharmaceuticals
- Tritium
- Levodopa
- Methoxyhydroxyphenylglycol
- 6-fluorodopamine
- 3,4-dihydroxyphenylglycol
- Dopamine
- Norepinephrine
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Topics |
- Adult
- Aged
- Blood Pressure
- Brain
(physiopathology)
- Cardiac Catheterization
- Diagnosis, Differential
- Dopamine
(analogs & derivatives)
- Female
- Fluorine Radioisotopes
- Heart
(diagnostic imaging, innervation)
- Heart Rate
- Humans
- Levodopa
(blood, therapeutic use)
- Male
- Methoxyhydroxyphenylglycol
(analogs & derivatives, blood)
- Middle Aged
- Multiple System Atrophy
(blood, drug therapy, physiopathology)
- Myocardium
(metabolism)
- Norepinephrine
(blood)
- Parkinson Disease
(blood, drug therapy, physiopathology)
- Radionuclide Imaging
- Radiopharmaceuticals
- Sympathetic Nervous System
(physiopathology)
- Tritium
- Valsalva Maneuver
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