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

Images in Cardiovascular Medicine

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

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

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

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

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

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

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

Patients with Parkinson’s disease frequently exhibit symptoms of autonomic failure that suggest derangements of the sympathetic and/or parasympathetic nervous . . . [Full Text of this Article]

This article has been cited by other articles:

				K. C. Allman Metoprolol-Induced Changes in Myocardial 123I-Metaiodobenzylguanidine Uptake in Parkinson's Disease Circulation, August 14, 2001; 104 (7): e37 - e37. [Full Text] [PDF]