Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 12/2004

01-12-2004

Challenging the neuronal MIBG uptake by pharmacological intervention: effect of a single dose of oral amitriptyline on regional cardiac MIBG uptake

Authors: Montserrat Estorch, Ignasi Carrió, Esther Mena, Albert Flotats, Valle Camacho, Jordi Fuertes, Jaume Kulisewsky, Jagat Narula

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 12/2004

Login to get access

Abstract

Purpose

Imaging with metaiodobenzylguanidine (MIBG) is used for the assessment of neuronal dysfunction in various cardiovascular disorders. Although valuable information is obtained by resting MIBG imaging, it is conceivable that competitive interference with the re-uptake mechanism would exaggerate MIBG defects and might unmask subclinical neuronal dysfunction. Tricyclic antidepressants, such as amitriptyline, have been reported to significantly increase cardiac MIBG washout and inhibit uptake into presynaptic neurons. This study was undertaken to assess whether a single oral dose of amitriptyline could influence cardiac MIBG distribution.

Methods

Six patients (aged 62–81 years; four males, two females) who had demonstrated a normal cardiac MIBG scan during work-up for movement disorders were studied. The patients underwent a second 123I-MIBG study after oral administration of 25 mg amitriptyline within 1 week. Single-photon emission computed tomography images were acquired at 4 h to assess the regional distribution of MIBG, after generation of polar maps and employing a 20-segment model. Mean percentage of peak activity was calculated for each segment at rest and after amitriptyline administration.

Results

After amitriptyline administration, there was a decrease in regional MIBG uptake in 10±4 segments per patient [62/120 segments (52%): 37 segments with a 5–10% decrease, 25 segments with a >10% decrease]. This change was statistically significant in lateral (P=0.003), apical (P<0.0001) and inferior (P=0.03) regions.

Conclusion

A single oral dose of amitriptyline can induce changes in the uptake and retention of cardiac MIBG, indicating the feasibility of use of pharmacological intervention in cardiac neurotransmission imaging.
Literature
1.
Dae MW, O’Connell J, Botvinick EH, et al. Scintigraphic assessment of regional cardiac innervation. Circulation 1989; 79:634–644.
2.
Sisson JC, Wieland DM, Sherman P, Mangner MC, Tobes MC, Jacques S. Metaiodobenzylguanidine as an index of adrenergic nervous system integrity and function. J Nucl Med 1987; 28:1620–1624.PubMed
3.
Sisson JC, Bolgos G, Jhonson J. Measuring acute changes in adrenergic nerve activity of the heart in the living animal. Am Heart J 1991; 121:1119–1123.CrossRefPubMed
4.
Knickmeier M, Matheja P, Wichter T, et al. Clinical evaluation of no-carrier-added meta-(123I)iodobenzylguanidine for myocardial scintigraphy. Eur J Nucl Med 2000; 3:302–307.CrossRef
5.
Merlet P, Valette H, Dubois-Rande JL, et al. Prognostic value of cardiac metaiodobenzylguanidine imaging in patients with heart failure. J Nucl Med 1992; 33:471–477.PubMed
6.
Merlet P, Benvenuti C, Moyse D, et al. Prognostic value of MIBG imaging in idiopathic dilated cardiomyopathy. J Nucl Med 1999; 40:917–923.PubMed
7.
Maunoury C, Agostini D, Acar P, et al. Impairment of cardiac neuronal function in childhood dilated cardiomyopathy: an I123-MIBG scintigraphic study. J Nucl Med 2000; 41:400–404.PubMed
8.
Udelson J, Shafer C, Carrió I. Radionuclide imaging in heart failure: assessing etiology and outcomes and implications for management. J Nucl Cardiol 2002; 5:S40–S52.CrossRef
9.
Carrio I. Cardiac neurotransmission imaging. J Nucl Med 2001; 42:1062–1076.PubMed
10.
Taki J, Nakajima K, Hwang EH, et al. Peripheral sympathetic dysfunction in patients with Parkinson’s disease without autonomic failure is heart selective and disease specific. Eur J Nucl Med 2000; 27:566–573.CrossRefPubMed
11.
Takatsu H, Nishida H, Matsuo H, et al. Cardiac sympathetic denervation from the early stage of Parkinson’s disease: clinical and experimental studies with radiolabeled MIBG. J Nucl Med 2000; 41:71–77.PubMed
12.
Yoshita M. Differentiation of idiopathic Parkinson’s disease from striatonogral degeneration and progressive supranuclear palsy using iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. J Neurol Sci 1998; 155:60–67.CrossRefPubMed
13.
American Society of Nuclear Cardiology. Imaging guidelines for nuclear cardiology procedures, Part 2. J Nucl Cardiol 1999; 6:G47–G84.PubMed
14.
Charney DS, Menkes DB, Heninger GR. Receptor sensitivity and the mechanism of action of antidepressant treatment. Arch Gen Psychiatry 1981; 38:1160–1180.PubMed
15.
Stahl SM, Grady MM. Differences in mechanism of action between current and future antidepressants. J Clin Psychiatry 2003; 64 Suppl 13:13–17.
16.
Malizia AL, Melichar JK, Rhodes CG, Haida A, Reynolds AH, Jones T, Nutt DJ. Desipramine binding to noradrenaline reuptake sites in cardiac sympathetic neurons in man in vivo. Eur J Pharmacol 2000; 391:263–267.CrossRefPubMed
17.
AHFS (American Hospital Formulary Service). Drug information (1990): antidepressants. In: McEvoy G, ed. AHFS drug information. Bethesda, MD: American Society of Hospital Pharmacists; 1990:1160–1161.
18.
Hollister LE. Tricyclic antidepressants. N Engl J Med 1978; 23:1168–1172.
19.
Preskorn SH, Irwin HA. Toxicity of tricyclic antidepressants: kinetics, mechanism, intervention. J Clin Psychiatry 1982; 43:151–156.PubMed
20.
Stahl SM, Grady MM. Differences in mechanism of action between current and future antidepressants. J Clin Psychiatry 2003; 64 Suppl 13:13–17.
21.
Huangfu D, Goodwin WB, Guyenet PG. Sympatholytic effect of tricyclic antidepressants: site and mechanism of action in anesthetized rats. Am J Physiol 1995; 268:R1429–R1441.PubMed
22.
Buckley NA, Chevalier S, Leditschke IA, et al. The limited utility of electrocardiography variables used to predict arrhythmia in psychotropic drug overdose. Crit Care 2003; 5:349–350.
23.
Perry PJ, Zeilmann C, Arndt S. Tricyclic antidepressant concentrations in plasma: an estimate of their sensitivity and specificity as a predictor of response. J Clin Psychopharmacol 1994; 14:230–240.PubMed
24.
Tsuchimochi S, Tamaki N, Tadamura E, et al. Age and gender differences in normal myocardial adrenergic neuronal function evaluated by iodine-123-MIBG imaging. J Nucl Med 1995; 6:969–974.
25.
Estorch M, Carrió I, Berná Ll, Lopez J, Torres G. Myocardial iodine-labeled metaiodobenzylguanidine uptake relates to age. J Nucl Cardiol 1995; 2:126–132.PubMed
26.
Gill JS, Hunter GJ, Gane G, Gamm AJ. Heterogeneity of the human myocardial sympathetic innervation: in vivo demonstration by iodine 123-labeled meta-iodobenzylguanidine scintigraphy. Am Heart J 1993; 2:390–398.
27.
Kiyono Y, Iida Y, Kawashima H, et al. Norepinephrine transporter density as a causative factor in alterations in MIBG myocardial uptake in NIDDM model rats. Eur J Nucl Med Mol Imaging 2002; 8:888–1005.
28.
Gerson MC, Craft LL, McGuire N, Suresh DP, Abraham WT, Wagoner LE. Carvedilol improves left ventricular function in heart failure patients with idiopathic dilated cardiomyopathy and a wide range of sympathetic nervous system function as measured by123I-metaiodobenzylguanidine. J Nucl Cardiol 2002; 9:608–615.CrossRefPubMed
29.
Toyama T, Hoshizaki H, Seki R, et al. Efficacy of carvedilol treatment on cardiac function and cardiac sympathetic nerve activity in patients with dilated cardiomyopathy: comparison with metoprolol activity. J Nucl Med 2003; 44:1604–1611.PubMed
30.
Yamazaki J, Muto H, Kabano T, Yamashina S, Nanjo S, Inoue A. Evaluation of beta-blocker therapy in patients with dilated cardiomyopathy—clinical meaning of iodine 123-metaiodobenzylguanidine myocardial single-photon emission computed tomography. Am Heart J 2001; 141:645–652.CrossRefPubMed
Metadata
Title
Challenging the neuronal MIBG uptake by pharmacological intervention: effect of a single dose of oral amitriptyline on regional cardiac MIBG uptake
Authors
Montserrat Estorch
Ignasi Carrió
Esther Mena
Albert Flotats
Valle Camacho
Jordi Fuertes
Jaume Kulisewsky
Jagat Narula
Publication date
01-12-2004
Publisher
Springer-Verlag
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 12/2004
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-004-1520-2

Other articles of this Issue 12/2004

European Journal of Nuclear Medicine and Molecular Imaging 12/2004 Go to the issue

Original Article

Imaging of dopamine transporters and D2 receptors in patients with Parkinson’s disease and multiple system atrophy

Original Article

Relation between wall thickening on gated perfusion SPECT and functional recovery after coronary revascularization in patients with previous myocardial infarction

Image of the Month

Splenectomy? No, thank you!

Original Articles

Prognostic value of fatty acid imaging in patients with angina pectoris without prior myocardial infarction: comparison with stress thallium imaging

Original Article

Variability of left ventricular ejection fraction and volumes with quantitative gated SPECT: influence of algorithm, pixel size and reconstruction parameters in small and normal-sized hearts

Editorial

Reflections after 1 year online