Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo 142-8666, Japan.
Eur J Nucl Med Mol Imaging. 2010 Apr;37(4):742-9. doi: 10.1007/s00259-009-1322-7. Epub 2009 Dec 17.
Neuronal system activity plays an important role for the prognosis of patients with atrial fibrillation (AF). Using (123)I metaiodobenzylguanidine ((123)I-MIBG) scintigraphy, we investigated whether a cardiac sympathetic nervous system (SNS) abnormality would be associated with an increased risk of vascular events in patients with paroxysmal AF.
(123)I-MIBG scintigraphy was performed in 69 consecutive patients (67 + or - 13 years, 62% men) with paroxysmal AF who did not have structural heart disease. SNS integrity was assessed from the heart to mediastinum (H/M) ratio on delayed imaging. Serum concentration of C-reactive protein (CRP) was measured before (123)I-MIBG study.
During a mean of 4.5 + or - 3.6 years follow-up, 19 patients had myocardial infarction, stroke or heart failure (range: 0.2-11.5 years). SNS abnormality (H/M ratio <2.7) and high CRP (> or = 0.3 mg/dl) were associated with the vascular events (58.3% in 14 of 24 patients with SNS abnormality vs 11.1% in 5 of 45 patients without SNS abnormality, p < 0.0001, 52.4% in 11 of 21 patients with high CRP vs 16.7% in 8 of 48 patients without high CRP, p < 0.0001). After adjustment for potential confounding variables such as age, left atrial dimension and left ventricular function, SNS abnormality was an independent predictor of vascular events with a hazard ratio of 4.1 [95% confidence interval (CI): 1.3-12.6, p = 0.014]. Further, SNS abnormality had an incremental and additive prognostic power in combination with high CRP with an adjusted hazard ratio of 4.1 (95% CI: 1.5-10.9, p = 0.006).
SNS abnormality is predictive of vascular events in patients with idiopathic paroxysmal AF.
神经元系统活动对心房颤动（AF）患者的预后起着重要作用。我们使用碘-123 间位碘苄胍（123I-MIBG）闪烁显像，研究阵发性 AF 患者心脏自主神经系统（SNS）异常是否与血管事件风险增加有关。
对 69 例无结构性心脏病的阵发性 AF 患者（67±13 岁，62%为男性）进行 123I-MIBG 闪烁显像。通过延迟显像的心脏与纵隔（H/M）比值评估 SNS 完整性。在 123I-MIBG 研究前测定血清 C 反应蛋白（CRP）浓度。
在平均 4.5±3.6 年的随访期间，19 例患者发生心肌梗死、卒中和心力衰竭（范围：0.2-11.5 年）。SNS 异常（H/M 比值<2.7）和 CRP 升高（≥0.3mg/dl）与血管事件相关（24 例 SNS 异常患者中有 14 例（58.3%）发生血管事件，45 例无 SNS 异常患者中有 5 例（11.1%）发生血管事件，p<0.0001；21 例 CRP 升高患者中有 11 例（52.4%）发生血管事件，48 例无 CRP 升高患者中有 8 例（16.7%）发生血管事件，p<0.0001）。校正年龄、左心房内径和左心室功能等潜在混杂因素后，SNS 异常是血管事件的独立预测因素，危险比为 4.1（95%可信区间：1.3-12.6，p=0.014）。此外，SNS 异常与 CRP 升高联合具有额外的预后价值，校正危险比为 4.1（95%可信区间：1.5-10.9，p=0.006）。
SNS 异常可预测特发性阵发性 AF 患者的血管事件。
