Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Eur J Nucl Med Mol Imaging. 2020 Jul;47(7):1657-1667. doi: 10.1007/s00259-019-04523-0. Epub 2019 Sep 9.
The effects of transcatheter aortic valve replacement (TAVR) on cardiac sympathetic nervous (CSN) function have not been fully explored. This study aimed to investigate the early (within 2 weeks) effects of TAVR on CSN function in patients with severe aortic valve stenosis (AS) using I-metaiodobenzylguanidine (MIBG) scintigraphy.
Of 143 consecutive patients who were scheduled to undergo TAVR, 67 (18 men; median age 86 years) were evaluated in this single-centre prospective observational study. MIBG scintigraphy was performed at baseline and 3-14 days after the TAVR procedure to evaluate the heart-mediastinum ratio (H/M) and washout rate (WR). Differences between baseline and post-TAVR MIBG parameters were analysed. MIBG parameter changes were compared with echocardiographic parameters. Furthermore, factors involved in the improvement in MIBG parameters were investigated.
All patients successfully underwent TAVR with improved echocardiographic parameters, including aortic valve area (AVA; 0.6 cm vs. 1.6 cm), peak velocity (4.5 m/s vs. 2.0 m/s), mean pressure gradient (50 mmHg vs. 9 mmHg), and left ventricular ejection fraction (56% vs. 62%) (all p < 0.001). On MIBG imaging, delayed H/M significantly increased (2.57 vs. 2.68, p < 0.001), whereas WR decreased (32.2% vs. 26.8%, p < 0.001). In multivariate analysis, higher baseline WR was associated with improvement in WR (> 3%). Female sex, Clinical Frailty Scale score ≤ 5, baseline estimated glomerular filtration rate, and baseline AVA were predictors of improvement in delayed H/M (> 0.1). Baseline AVA and E/E' were independent predictors of improvement in both WR and delayed H/M.
The CSN function was impaired in patients with AS, as assessed using MIBG scintigraphy. WR and delayed H/M improved immediately after TAVR. Improvement in CSN function may be related to echocardiographic AS severity at baseline before TAVR.
经导管主动脉瓣置换术（TAVR）对心脏交感神经（CSN）功能的影响尚未完全被探究。本研究旨在通过碘-间位碘苄胍（MIBG）闪烁扫描术来探究 TAVR 对严重主动脉瓣狭窄（AS）患者 CSN 功能的早期（2 周内）影响。
在接受 TAVR 的 143 例连续患者中，67 例（18 名男性；中位年龄 86 岁）被纳入这项单中心前瞻性观察性研究。在 TAVR 术前和术后 3-14 天进行 MIBG 闪烁扫描术，以评估心脏-纵隔比（H/M）和洗脱率（WR）。分析基线和 TAVR 后 MIBG 参数的差异。比较 MIBG 参数变化与超声心动图参数。此外，还研究了影响 MIBG 参数改善的因素。
所有患者均成功接受了 TAVR 治疗，且超声心动图参数得到改善，包括主动脉瓣口面积（AVA；0.6cm 比 1.6cm）、峰值速度（4.5m/s 比 2.0m/s）、平均压力梯度（50mmHg 比 9mmHg）和左心室射血分数（56%比 62%）（均 p<0.001）。在 MIBG 成像上，延迟 H/M 显著增加（2.57 比 2.68，p<0.001），而 WR 降低（32.2% 比 26.8%，p<0.001）。多变量分析显示，较高的基线 WR 与 WR 改善（>3%）相关。女性、临床虚弱量表评分≤5、基线估计肾小球滤过率和基线 AVA 是延迟 H/M 改善（>0.1）的预测因素。基线 AVA 和 E/E'是 WR 和延迟 H/M 改善的独立预测因素。
通过 MIBG 闪烁扫描术评估，AS 患者的 CSN 功能受损。WR 和延迟 H/M 在 TAVR 后即刻改善。CSN 功能的改善可能与 TAVR 前基线时的超声心动图 AS 严重程度有关。
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