慢性心力衰竭患者运动期间心脏去甲肾上腺素溢出与心脏123I-间碘苄胍摄取之间的相关性

Correlation between cardiac norepinephrine overflow during exercise and cardiac 123I-MIBG uptake in patients with chronic heart failure.

作者信息

Sato Masahiko, Maehara Kazuhira, Yaoita Hiroyuki, Otani Hiroshi, Hirosaka Akira, Saito Tomiyoshi, Onuki Norio, Komatsu Nobuo, Ishihata Takako, Maruyama Yukio

机构信息

First Department of Internal Medicine, Fukushima Medical University, Hikarigaoka, Fukushima, Japan.

出版信息

J Nucl Med. 2003 Oct;44(10):1618-24.

PMID:14530476

Abstract

UNLABELLED

Cardiac (123)I-metaiodobenzylguanidine ((123)I-MIBG) uptake is reduced in chronic heart failure, and its reduction is reported to relate to the decrease in exercise capacity. Reduced (123)I-MIBG uptake may predict an inadequately reduced adrenergic drive to the heart during cardiac sympathetic stimulation, including exercise. However, there is little information about the relationship between cardiac (123)I-MIBG uptake at rest and norepinephrine (NE) release during exercise in relation to the exercise capacity in the failing heart. The aim of this study was to examine whether cardiac (123)I-MIBG uptake at rest can predict cardiac sympathetic activity during exercise in patients with chronic heart failure. We determined how cardiac (123)I-MIBG uptake at rest relates to NE overflow from the heart during symptom-limited graded exercise in such patients.

METHODS

Twelve patients (mean +/- SD, 52 +/- 12 y) with chronic stable heart failure performed symptom-limited graded exercise tests under catheterizations with a 4-min stage using a supine bicycle ergometer within 2 wk after (123)I-MIBG imaging. NE concentrations in the arterial and coronary sinus blood (NE(A) and NE(CS), respectively) were measured at each exercise stage, and NE overflow was approximated by the difference between NE(CS) and NE(A) (NE(CS-A)).

RESULTS

The left ventricular ejection fraction at rest was 47% +/- 16% and peak oxygen uptake was 17.7 +/- 5.1 mL/kg/min. The heart-to-mediastinum uptake ratio of the delayed (123)I-MIBG image (1.00 - 1.72; mean +/- SD, 1.30 +/- 0.19) correlated with NE(CS-A) at peak exercise (r = 0.80, P < 0.01) and peak heart rate (r = 0.73, P < 0.01) but not with peak oxygen uptake.

CONCLUSION

Cardiac (123)I-MIBG uptake of the delayed image can predict the degree of the increase in adrenergic drive to the heart during sympathetic stimuli induced by exercise in patients with chronic heart failure.

摘要

未标记

慢性心力衰竭患者心脏对（123）I-间碘苄胍（（123）I-MIBG）的摄取减少，据报道其减少与运动能力下降有关。（123）I-MIBG摄取减少可能预示着在包括运动在内的心脏交感神经刺激期间，心脏的肾上腺素能驱动未能充分降低。然而，关于衰竭心脏静息时心脏（123）I-MIBG摄取与运动期间去甲肾上腺素（NE）释放之间的关系以及与运动能力的关系，目前知之甚少。本研究的目的是探讨慢性心力衰竭患者静息时心脏（123）I-MIBG摄取是否能够预测运动期间的心脏交感神经活动。我们确定了此类患者在症状限制的分级运动期间，静息时心脏（123）I-MIBG摄取与心脏NE溢出之间的关系。

方法

12例（平均±标准差，52±12岁）慢性稳定型心力衰竭患者在（123）I-MIBG显像后2周内，使用仰卧位自行车测力计在导管插入术下进行症状限制的分级运动试验，每个阶段持续4分钟。在每个运动阶段测量动脉血和冠状窦血中的NE浓度（分别为NE（A）和NE（CS）），NE溢出通过NE（CS）与NE（A）之间的差值（NE（CS-A））来估算。

结果

静息时左心室射血分数为47%±16%，峰值摄氧量为17.7±5.1 mL/kg/min。延迟（123）I-MIBG图像的心脏与纵隔摄取比值（1.00 - 1.72；平均±标准差，1.30±0.19）与运动峰值时的NE（CS-A）（r = 0.80，P < 0.01）和峰值心率（r = 0.73，P < 0.01）相关，但与峰值摄氧量无关。