Key result
Low intraepidermal nerve fiber density correlated with reduced cardiac MIBG uptake in patients with postural tachycardia syndrome (r = 0.39, P = 0.001).
Why the study?
Does intraepidermal nerve fiber density correlate with cardiac sympathetic innervation in patients with POTS?
Observational (n=84)
Does intraepidermal nerve fiber density correlate with cardiac sympathetic innervation in patients with POTS?
In patients with POTS, reduced intraepidermal nerve fiber density correlates with reduced cardiac sympathetic innervation, suggesting a subset has mild small fiber neuropathy.
Answers are grounded in this paper and cite their sources.
Suggests overlapping neuropathy and sympathetic denervation in POTS; hypothesis-generating and requires prospective validation before clinical adoption.
INTRODUCTION: Postural tachycardia syndrome (POTS) is a disorder of orthostatic intolerance characterized by excessive tachycardia of unknown etiology. Our objective in this study was to evaluate the correlation between C-fiber involvement as shown by skin biopsy and adrenergic cardiac metaiodobenzylguanadine (MIBG) uptake in POTS patients. METHODS: Skin biopsies of 84 patients with POTS were examined by Protein Gene Product 9.5 (PGP9.5) immunohistochemistry and were compared with MIBG myocardial scintigraphy imaging data. RESULTS: Mean intraepidermal nerve fiber (IENF) density was in the lower normal age-adjusted range, 7.2 ± 2.9/mm (normal ≥ 7/mm), and was slightly below the normal range in 45% of POTS patients. MIBG uptake was reduced in 21% of patients. Low IENF density correlated with reduced cardiac MIBG uptake (r = 0.39, P = 0.001). CONCLUSIONS: A subset of neuropathic POTS patients may harbor mild small fiber neuropathy with abnormalities of unmyelinated nerve fibers in the skin associated with reduced myocardial postganglionic sympathetic innervation.
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Haensch et al. (2014) conducted an observational in Postural tachycardia syndrome (POTS) (n=84). Skin biopsy and MIBG myocardial scintigraphy was evaluated on Correlation between intraepidermal nerve fiber (IENF) density and cardiac MIBG uptake (r = 0.39, p=0.001). Low intraepidermal nerve fiber density correlated with reduced cardiac MIBG uptake in patients with postural tachycardia syndrome (r = 0.39, P = 0.001).
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