Bax Jeroen J, Kraft Otakar, Buxton Alfred E, Fjeld Jan Gunnar, Parízek Petr, Agostini Denis, Knuuti Juhani, Flotats Albert, Arrighi James, Muxi Africa, Alibelli Marie-Jeanne, Banerjee Gopa, Jacobson Arnold F
Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands.
Circ Cardiovasc Imaging. 2008 Sep;1(2):131-40. doi: 10.1161/CIRCIMAGING.108.782433. Epub 2008 Jul 30.
Disturbances of autonomic function after infarction are associated with both total mortality and sudden death. Although many imaging techniques for assessing the cardiac autonomic nervous system have been studied, the clinical usefulness of these techniques remains uncertain. This exploratory pilot study examined the relationship between abnormalities of ventricular sympathetic innervation delineated by scintigraphic imaging with (123)I-mIBG and inducible ventricular tachyarrhythmias in patients with left ventricular dysfunction and previous myocardial infarction.
Fifty patients underwent electrophysiological (EP) testing and 15-minute and 4-hour planar and single photon emission computed tomography (SPECT) imaging with (123)I-mIBG and SPECT imaging with (99m)Tc-tetrofosmin. The primary efficacy variables were the 4-hour heart:mediastinum ratio (H/M) and the (123)I-mIBG/(99m)Tc-tetrofosmin SPECT mismatch score. EP studies were categorized as positive (EP(+)) or negative (EP(-)) for inducibility of sustained (>30 seconds) ventricular tachyarrhythmias. Thirty patients were EP(+), and 20 were EP(-). There were no significant differences in the 4-hour H/M ratios or (123)I-mIBG/(99m)Tc-tetrofosmin SPECT mismatch scores between the two groups. In a multivariable analysis using all (123)I-mIBG and (99m)Tc-tetrofosmin SPECT measurements, the only variable that showed a significant difference between EP(+) and EP(-) patients was the 4-hour (123)I-mIBG SPECT defect score. A 4-hour (123)I-mIBG SPECT defect score of > or =37 yielded a sensitivity of 77% and specificity of 75% for predicting EP results.
The standard indices of (123)I-mIBG imaging (H/M and innervation-perfusion mismatch score) are not predictive of EP test results. The association of (123)I-mIBG SPECT defect severity with EP test inducibility in this exploratory study will require confirmation in a larger cohort of patients.
梗死之后自主神经功能紊乱与总死亡率和猝死均相关。尽管已经对许多评估心脏自主神经系统的成像技术进行了研究，但这些技术的临床实用性仍不确定。这项探索性初步研究检测了在左心室功能不全和既往心肌梗死患者中，通过闪烁显像术用（123）I-间碘苄胍描绘的心室交感神经支配异常与可诱导性室性快速心律失常之间的关系。
50例患者接受了电生理（EP）检查以及用（123）I-间碘苄胍进行的15分钟和4小时平面及单光子发射计算机断层扫描（SPECT）成像，并用（99m）锝-替曲膦进行SPECT成像。主要疗效变量为4小时心脏：纵隔比率（H/M）以及（123）I-间碘苄胍/（99m）锝-替曲膦SPECT不匹配分数。EP研究根据持续性（>30秒）室性快速心律失常的可诱导性分为阳性（EP(+)）或阴性（EP(-)）。30例患者为EP(+)，20例为EP(-)。两组之间的4小时H/M比率或（123）I-间碘苄胍/（99m）锝-替曲膦SPECT不匹配分数无显著差异。在使用所有（123）I-间碘苄胍和（99m）锝-替曲膦SPECT测量值的多变量分析中，在EP(+)和EP(-)患者之间显示出显著差异的唯一变量是4小时（123）I-间碘苄胍SPECT缺损分数。4小时（123）I-间碘苄胍SPECT缺损分数≥37对于预测EP结果的敏感性为77%，特异性为75%。
（123）I-间碘苄胍成像的标准指标（H/M和神经支配-灌注不匹配分数）不能预测EP检查结果。在这项探索性研究中，（123）I-间碘苄胍SPECT缺损严重程度与EP检查可诱导性之间的关联需要在更大的患者队列中得到证实。
