Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland.
Center for Molecular Cardiology University of Zurich Switzerland.
J Am Heart Assoc. 2019 Oct;8(19):e013070. doi: 10.1161/JAHA.119.013070. Epub 2019 Sep 30.
Background Increasing evidence suggests a psychosomatic link between neural systems and the heart. In light of the growing burden of ischemic cardiovascular disease across the globe, a better understanding of heart-brain interactions and their implications for cardiovascular treatment strategies is needed. Thus, we sought to investigate the interaction between myocardial injury and metabolic alterations in central neural areas in patients with suspected or known coronary artery disease. Methods and Results The association between resting metabolic activity in distinct neural structures and cardiac function was analyzed in 302 patients (aged 66.8±10.2 years; 70.9% men) undergoing fluor-18-deoxyglucose positron emission tomography and Tc-tetrofosmin single-photon emission computed tomography myocardial perfusion imaging. There was evidence for reduction of callosal, caudate, and brainstem fluor-18-deoxyglucose uptake in patients with impaired left ventricular ejection fraction (<55% versus ≥55%: =0.047, =0.022, and =0.013, respectively) and/or in the presence of myocardial ischemia (versus normal perfusion: =0.010, =0.013, and =0.016, respectively). In a sex-stratified analysis, these differences were observed in men, but not in women. A first-order interaction term consisting of sex and impaired left ventricular ejection fraction or myocardial ischemia was identified as predictor of metabolic activity in these neural regions (left ventricular ejection fraction: =0.015 for brainstem; myocardial ischemia: =0.004, =0.018, and =0.003 for callosal, caudate, or brainstem metabolism, respectively). Conclusions Myocardial dysfunction and injury are associated with reduced resting metabolic activity of central neural structures, including the corpus callosum, the caudate nucleus, and the brainstem. These associations differ in women and men, suggesting sex differences in the pathophysiological interplay of the nervous and cardiovascular systems.
越来越多的证据表明，神经系统与心脏之间存在身心联系。鉴于全球缺血性心血管疾病负担不断增加，需要更好地了解心脏-大脑相互作用及其对心血管治疗策略的影响。因此，我们试图研究疑似或已知冠状动脉疾病患者中心神经区域心肌损伤和代谢改变之间的相互作用。
在 302 名接受氟-18-脱氧葡萄糖正电子发射断层扫描和 Tc-四氮茂单光子发射计算机断层扫描心肌灌注成像的患者中，分析了不同神经结构中静息代谢活性与心脏功能之间的关系。结果显示，与左心室射血分数（<55%比≥55%：=0.047，=0.022，=0.013）受损和/或存在心肌缺血的患者相比，胼胝体、尾状核和脑干氟-18-脱氧葡萄糖摄取减少（=0.010，=0.013，=0.016）。在按性别分层的分析中，这些差异仅在男性中观察到，而在女性中则未观察到。性别和左心室射血分数或心肌缺血的一阶交互项被确定为这些神经区域代谢活性的预测因子（左心室射血分数：脑干=0.015；心肌缺血：胼胝体=0.004，尾状核=0.018，脑干=0.003）。
心肌功能障碍和损伤与中枢神经结构（包括胼胝体、尾状核和脑干）的静息代谢活性降低有关。这些关联在女性和男性中不同，提示神经系统和心血管系统病理生理相互作用存在性别差异。
