碘-123 间碘苄胍显像预测心房颤动的发生。
Iodine-123 mIBG Imaging for Predicting the Development of Atrial Fibrillation.
机构信息
Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
出版信息
JACC Cardiovasc Imaging. 2011 Jan;4(1):78-86. doi: 10.1016/j.jcmg.2010.10.005.
OBJECTIVES
we investigated whether cardiac sympathetic nervous system (SNS) activity measured by iodine-123 meta-iodobenzylguanidine ((123)I-mIBG) imaging would be associated with both the occurrence of heart failure (HF) and the transit to permanent atrial fibrillation (AF) in patients with paroxysmal AF.
BACKGROUND
atrial fibrillation occurs suddenly and transiently and can persist, and results in the occurrence of HF. An important feature of AF and HF is their propensity to coexist not only because they share antecedent risk factors, but also because the one may directly predispose the heart to the other. However, a useful modality for predicting the occurrences of both those has not been established in patients with paroxysmal AF.
METHODS
the (123)I-mIBG scintigraphy was performed to evaluate cardiac SNS activity presented as the heart/mediastinum ratio in 98 consecutive patients (age 66 ± 13 years, 63.3% male) with idiopathic paroxysmal AF and preserved left ventricular ejection fraction (≥ 50%).
RESULTS
during 4 ± 3.6 years of follow-up, the transit to permanent AF was associated with the occurrence of HF (34.3% in 12 of 35 patients with permanent AF vs. 6.3% in 4 of 63 patients without, p < 0.0001). Lower heart/mediastinum ratio and lower left ventricular ejection fraction were the independent predictors of the transit to permanent AF with adjusted hazard ratios of 3.44 (95% confidence interval [CI]: 1.9 to 6.2, p < 0.0001) and 1.04 (95% CI: 1.01 to 1.08, p = 0.014). Further, these factors and higher plasma brain natriuretic peptide concentration were the independent predictors of the occurrence of HF with permanent AF, with adjusted hazard ratios of 5.08 (95% CI: 1.5 to 17.5, p = 0.011), 1.11 (95% CI: 1.03 to 1.19, p = 0.004), and 1.004 (95% CI: 1.001 to 1.008, p = 0.014).
CONCLUSIONS
cardiac SNS abnormality was associated with the occurrence of both HF and permanent AF in paroxysmal AF patients, and (123)I-mIBG imaging may be a useful modality for predicting the development of AF.
目的
我们研究了碘-123 间位碘代苄胍（123I-mIBG）成像测量的心脏交感神经系统（SNS）活性是否与阵发性房颤患者心力衰竭（HF）的发生和永久性房颤（AF）的进展有关。
背景
房颤突然发生且短暂，并可能持续存在，导致 HF 的发生。房颤和 HF 的一个重要特征是它们不仅因为有共同的前置风险因素而倾向于共存，还因为其中一个可能直接使心脏易患另一个。然而，在阵发性房颤患者中，尚未建立预测这两种情况发生的有用方法。
方法
对 98 例特发性阵发性房颤且左心室射血分数正常（≥50%）的患者（年龄 66±13 岁，63.3%为男性）进行 123I-mIBG 闪烁显像，以评估心脏 SNS 活性，表现为心脏/纵隔比值。
结果
在 4±3.6 年的随访期间，永久性房颤的发生与 HF 的发生有关（35 例永久性房颤患者中有 12 例发生，发生率为 34.3%，63 例无永久性房颤患者中有 4 例发生，发生率为 6.3%，p<0.0001）。较低的心脏/纵隔比值和较低的左心室射血分数是永久性房颤进展的独立预测因素，调整后的危险比分别为 3.44（95%置信区间[CI]：1.9 至 6.2，p<0.0001）和 1.04（95%CI：1.01 至 1.08，p=0.014）。此外，这些因素和较高的血浆脑钠肽浓度是永久性房颤合并 HF 发生的独立预测因素，调整后的危险比分别为 5.08（95%CI：1.5 至 17.5，p=0.011）、1.11（95%CI：1.03 至 1.19，p=0.004）和 1.004（95%CI：1.001 至 1.008，p=0.014）。
结论
心脏 SNS 异常与阵发性房颤患者 HF 和永久性房颤的发生有关，123I-mIBG 成像可能是预测房颤发展的有用方法。
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