Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy.
Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
J Nucl Cardiol. 2018 Aug;25(4):1101-1109. doi: 10.1007/s12350-016-0753-3. Epub 2016 Dec 27.
A possible relationship between cardiac sympathetic denervation and left ventricular (LV) diastolic dysfunction has been suggested. However, an evaluation of the interactions between myocardial adrenergic tone and LV perfusion and diastolic function is lacking.
Seventy-two patients underwent Tc-tetrofosmin/I-metaiodobenzylguanidine (I-MIBG) cardiac Cadmium-Zinc-Telluride (CZT) imaging. The summed rest score (SRS) and summed I-MIBG score (SS-MIBG) were computed as measures of regional perfusion and innervation heterogeneities. LV segments showing an impaired innervation, despite a relatively preserved perfusion (Tc-tetrofosmin-I-MIBG tracers' uptake ≥25%), were individuated (innervation/perfusion mismatch). The peak filling rate (PFR) was computed as a measure of LV diastolic function. Nineteen of the 72 (26%) patients presented a normal LV diastolic function, while 29 (40%) and 24 (34%) had a mild and overt diastolic dysfunction. Subjects with diastolic dysfunction showed more abnormal SRS and SS-MIBG values (P < 0.001). In the global population, 502/1224 (41%) LV segments showed an innervation/perfusion mismatch. A modest correlation between the extent of cardiac innervation/perfusion mismatch and PFR values was evident (R = -0.27, P = 0.029). On multivariate analysis, the extent of regional innervation/perfusion mismatch remained an independent predictor of overt LV diastolic abnormalities (P = 0.017).
The burden of LV regions showing an innervation/perfusion mismatch associates with the occurrence of overt diastolic dysfunction.
心脏交感神经去神经支配与左心室（LV）舒张功能障碍之间可能存在关系。然而，缺乏对心肌肾上腺素能张力与 LV 灌注和舒张功能之间相互作用的评估。
72 例患者接受了 Tc-四氮唑/碘-间位碘苄胍（I-MIBG）心脏镉锌碲（CZT）成像。计算总和休息评分（SRS）和总和 I-MIBG 评分（SS-MIBG）作为区域性灌注和神经支配异质性的指标。尽管 LV 段的灌注相对保留（Tc-四氮唑-I-MIBG 示踪剂摄取≥25%），但仍存在神经支配受损的 LV 段（神经支配/灌注不匹配）。峰值充盈率（PFR）被计算为 LV 舒张功能的指标。72 例患者中，19 例（26%）患者的 LV 舒张功能正常，29 例（40%）和 24 例（34%）患者有轻度和明显的舒张功能障碍。舒张功能障碍患者的 SRS 和 SS-MIBG 值更异常（P<0.001）。在整个人群中，502/1224（41%）个 LV 节段表现出神经支配/灌注不匹配。心脏神经支配/灌注不匹配的程度与 PFR 值之间存在适度的相关性（R=-0.27，P=0.029）。多变量分析显示，区域神经支配/灌注不匹配的程度仍然是明显 LV 舒张异常的独立预测因子（P=0.017）。
LV 区域神经支配/灌注不匹配的负担与明显舒张功能障碍的发生相关。
