TY - JOUR
T1 - Cardiac sympathetic dysautonomia in chronic orthostatic intolerance syndromes
AU - Goldstein, David S.
AU - Holmes, Courtney
AU - Frank, Steven M.
AU - Dendi, Raghuveer
AU - Cannon, Richard O.
AU - Sharabi, Yehonatan
AU - Esler, Murray D.
AU - Eisenhofer, Graeme
PY - 2002/10/29
Y1 - 2002/10/29
N2 - Background - In postural tachycardia syndrome (POTS) and repeated neurocardiogenic presyncope (NCS), orthostatic intolerance occurs without persistent sympathetic neurocirculatory failure. Whether these conditions involve abnormal cardiac sympathetic innervation or function has been unclear. Methods and Results - Patients with POTS or NCS underwent measurements of neurochemical indices of cardiac release, reuptake, and synthesis of the sympathetic neurotransmitter norepinephrine based on entry of norepinephrine into the cardiac venous drainage (cardiac norepinephrine spillover), cardiac extraction of circulating 3H-norepinephrine, and cardiac production of dihydroxyphenylalanine and measurement of left ventricular myocardial innervation density using 6-[18F]fluorodopamine positron emission tomographic scanning. Mean cardiac norepinephrine spillover in POTS (171±30 pmol/min, N=16) was higher and in NCS (62±9 pmol/min, N=20) was lower than in a large group of healthy volunteers (102±9 pmol/min, N=52) and in a subgroup of age-matched healthy women (106±18 pmol/min, N=11). Both patient groups had normal cardiac extraction of 3H-norepinephrine, normal cardiac production of dihydroxyphenylalanine, and normal myocardial 6-[18F]fluorodopamine-derived radioactivity. Conclusions - POTS and NCS differ in tonic cardiac sympathetic function, with increased cardiac norepinephrine release in the former and decreased release in the latter. Both groups had normal values for indices of function of the cell membrane norepinephrine transporter, norepinephrine synthesis, and density of myocardial sympathetic innervation. Because POTS and NCS both include specific abnormalities of cardiac sympathetic function, both can be considered forms of dysautonomia.
AB - Background - In postural tachycardia syndrome (POTS) and repeated neurocardiogenic presyncope (NCS), orthostatic intolerance occurs without persistent sympathetic neurocirculatory failure. Whether these conditions involve abnormal cardiac sympathetic innervation or function has been unclear. Methods and Results - Patients with POTS or NCS underwent measurements of neurochemical indices of cardiac release, reuptake, and synthesis of the sympathetic neurotransmitter norepinephrine based on entry of norepinephrine into the cardiac venous drainage (cardiac norepinephrine spillover), cardiac extraction of circulating 3H-norepinephrine, and cardiac production of dihydroxyphenylalanine and measurement of left ventricular myocardial innervation density using 6-[18F]fluorodopamine positron emission tomographic scanning. Mean cardiac norepinephrine spillover in POTS (171±30 pmol/min, N=16) was higher and in NCS (62±9 pmol/min, N=20) was lower than in a large group of healthy volunteers (102±9 pmol/min, N=52) and in a subgroup of age-matched healthy women (106±18 pmol/min, N=11). Both patient groups had normal cardiac extraction of 3H-norepinephrine, normal cardiac production of dihydroxyphenylalanine, and normal myocardial 6-[18F]fluorodopamine-derived radioactivity. Conclusions - POTS and NCS differ in tonic cardiac sympathetic function, with increased cardiac norepinephrine release in the former and decreased release in the latter. Both groups had normal values for indices of function of the cell membrane norepinephrine transporter, norepinephrine synthesis, and density of myocardial sympathetic innervation. Because POTS and NCS both include specific abnormalities of cardiac sympathetic function, both can be considered forms of dysautonomia.
KW - Catecholamines
KW - Dysautonomia
KW - Nervous system, sympathetic
KW - Norepinephrine
UR - http://www.scopus.com/inward/record.url?scp=0037195061&partnerID=8YFLogxK
U2 - 10.1161/01.CIR.0000036015.54619.B6
DO - 10.1161/01.CIR.0000036015.54619.B6
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C2 - 12403667
AN - SCOPUS:0037195061
VL - 106
SP - 2358
EP - 2365
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 18
ER -