Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy.
Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
J Nucl Cardiol. 2021 Feb;28(1):175-183. doi: 10.1007/s12350-018-01575-x. Epub 2019 Jan 2.
Sympathetic dys-innervation may play an important role in the development of post-ischemic ventricular arrhythmias (VA). Aim of this study was to prove that perfusion/innervation mismatch (PIM) evaluated by SPECT can identify areas of local abnormal ventricular activities (LAVA) on electroanatomic mapping (EAM).
Sixteen patients referred to post-ischemic VA catheter ablation underwent pre-procedural and 1-month post-ablation I-MIBG/Tc-tetrofosmin rest SPECT myocardial imaging. PIM was defined according to the segmental distributions of 99mTc-tetrofosmin and 123I-MIBG. A 17-segment LV analysis was used for either SPECT or LV EAM voltage map. All patients were followed up clinically for at least 1 year.
Before ablation, the mean voltage in the PIM segments was higher than in the scarred ones but lower than in the normal regions. The presence of PIM in a specific LV zone was an independent predictor of LAVA. After ablation, PIM value was significantly reduced, mainly due to an increase in perfusion summed rest score, in particular in patients that were responders to ablation.
PIM may associate with VA substrate expressed by LAVA and might provide a novel guide for substrate ablation. A significant reduction of PIM could predict a positive clinical response to ablation.
交感神经功能障碍可能在缺血后室性心律失常（VA）的发展中起重要作用。本研究旨在证明通过 SPECT 评估的灌注/神经支配不匹配（PIM）可以识别电解剖图（EAM）上局部异常室性活动（LAVA）的区域。
16 名因缺血后 VA 导管消融术而转介的患者在术前和消融后 1 个月接受 I-MIBG/Tc-甲氧基异丁基异腈静息 SPECT 心肌成像。根据 99mTc-甲氧基异丁基异腈和 123I-MIBG 的节段分布定义 PIM。对于 SPECT 或 LV EAM 电压图，均使用 17 节段 LV 分析。所有患者均至少随访 1 年。
消融前，PIM 节段的平均电压高于瘢痕区，但低于正常区。特定 LV 区域存在 PIM 是 LAVA 的独立预测因子。消融后，PIM 值显著降低，主要是由于灌注总和静息评分增加，特别是在消融反应良好的患者中。
PIM 可能与 LAVA 表达的 VA 基质相关，可能为基质消融提供新的指导。PIM 的显著减少可以预测消融的阳性临床反应。
