在冠状动脉疾病极早期的无症状受试者中，心脏肾上腺素能神经支配会受到影响。

Cardiac adrenergic innervation is affected in asymptomatic subjects with very early stage of coronary artery disease.

作者信息

Simula Sakari, Vanninen Esko, Viitanen Laura, Kareinen Anu, Lehto Seppo, Pajunen Pia, Syvänne Mikko, Kuikka Jyrki, Laakso Markku, Hartikainen Juha

机构信息

Department of Medicine, Kuopio University Hospital, Kuopio, Finland.

出版信息

J Nucl Med. 2002 Jan;43(1):1-7.

PMID:11801695

Abstract

UNLABELLED

The aim of this study was to investigate whether, in subjects with a very early stage of coronary artery disease without hemodynamically significant coronary artery stenoses, cardiac adrenergic innervation is already affected.

METHODS

Quantitative coronary angiography and dual-isotope SPECT with 123I-metaiodobenzylguanidine (MIBG) and 99mTc-sestamibi (MIBI) were conducted to assess the function of cardiac adrenergic innervation and myocardial perfusion, respectively, in 30 asymptomatic volunteers with a high familial risk for coronary artery disease. Regional quantitative analysis of MIBG uptake and washout rates was performed using the SPECT data from the anteroseptal, lateral, and inferior myocardial regions, which represented vascular supply by the left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), and right coronary artery (RCA), respectively.

RESULTS

The average severity of stenoses was 33% +/- 11% in the LAD, 29% +/- 14% in the LCX, and 26% +/- 19% in the RCA. The severity of stenosis was not related to MIBI uptake in any corresponding myocardial region at rest or during exercise. However, the degree of LAD stenosis correlated directly with delayed MIBG uptake (r = 0.43; P < 0.05) and inversely with MIBG washout (r = -0.34; P = 0.06) of the anteroseptal myocardium. When subjects were divided into tertiles according to the separate severity of stenosis for each coronary artery, delayed MIBG uptake in the anteroseptal region was significantly lower in the lowest LAD tertile (0.34 +/- 0.05) than in the middle (0.41 +/- 0.06; P < 0.01) or highest (0.43 +/- 0.05; P < 0.001) LAD tertile. Correspondingly, delayed MIBG uptake in the lateral region was also lower in the lowest LCX tertile than in the middle tertile (0.34 +/- 0.04 vs. 0.41 +/- 0.06, respectively; P < 0.01). Washout rate was also higher in the lowest LAD tertile (44% +/- 7%) than in the middle (36% +/- 10%; P < 0.05) or highest LAD tertile (34% +/- 8%; P < 0.01).

CONCLUSION

The degree of coronary artery stenosis was associated directly with MIBG uptake and inversely with MIBG washout. This finding suggests that the function of cardiac adrenergic nerve endings is modified even in mild coronary artery disease before denervation occurs.

摘要

未标注

本研究的目的是调查在冠状动脉疾病极早期且无血流动力学显著意义的冠状动脉狭窄的受试者中，心脏肾上腺素能神经支配是否已受到影响。

方法

对30名有冠状动脉疾病高家族风险的无症状志愿者进行定量冠状动脉造影以及使用123I-间碘苄胍（MIBG）和99mTc-甲氧基异丁基异腈（MIBI）的双同位素单光子发射计算机断层显像（SPECT），分别评估心脏肾上腺素能神经支配功能和心肌灌注。使用来自前间隔、侧壁和下壁心肌区域的SPECT数据进行MIBG摄取和洗脱率的区域定量分析，这些区域分别由左前降支冠状动脉（LAD）、左旋支冠状动脉（LCX）和右冠状动脉（RCA）供血。

结果

LAD狭窄的平均严重程度为33%±11%，LCX为29%±14%，RCA为26%±19%。狭窄严重程度与静息或运动时任何相应心肌区域的MIBI摄取均无关。然而，LAD狭窄程度与前间隔心肌的MIBG摄取延迟直接相关（r = 0.43；P < 0.０5），与MIBG洗脱呈负相关（r = -0.34；P = 0.06）。当根据每条冠状动脉狭窄的单独严重程度将受试者分为三分位数时，前间隔区域的MIBG摄取延迟在LAD最低三分位数组（0.34±0.05）显著低于中间三分位数组（0.41±0.06；P < 0.01）或最高三分位数组（0.43±0.05；P < 0.001）。相应地，侧壁区域的MIBG摄取延迟在LCX最低三分位数组也低于中间三分位数组（分别为0.34±0.04对0.41±0.06；P < 0.01）。LAD最低三分位数组的洗脱率（44%±7%）也高于中间三分位数组（36%±10%；P < 0.05）或最高三分位数组（34%±8%；P < 0.01）。