Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan.
Division of Cardiology, Osaka General Medical Center, 3-1-56 Mandaihigashi, Sumiyoshi-ku, Osaka, 558-8558, Japan.
Eur J Nucl Med Mol Imaging. 2022 Jan;49(2):609-618. doi: 10.1007/s00259-021-05280-9. Epub 2021 Mar 14.
The relationship between general obesity or abdominal obesity (abdominal circumference of ≥85 cm in men and ≥ 90 cm in women) and the heart-to-mediastinum ratio (HMR), a measure of cardiac sympathetic innervation, on cardiac iodine-123-metaiodobenzylguanidine scintigraphy (MIBG) in patients with heart failure with preserved ejection fraction (HFpEF) has not been clarified.
A total of 239 HFpEF patients with both MIBG and abdominal circumference data were examined. We divided these patients into those with abdominal obesity and those without it. In the cardiac MIBG study, early phase image was acquired 15-20 min after injection, and late phase image was acquired 3 h after the early phase. A HMR obtained from a low-energy type collimator was converted to that obtained by a medium-energy type collimator.
Early and late HMRs were significantly lower in those with abdominal obesity, although washout rates were not significantly different. The incidence of patients with early and late HMRs <2.2 was significantly higher in those with abdominal obesity. Multivariate linear regression analysis revealed that abdominal obesity was independently associated with early HMR (standardized β = -0.253, P = 0.003) and late HMR (standardized β = -0.222, P = 0.010). Multivariate logistic regression analysis revealed that abdominal obesity was independently associated with early (odds ratio [OR] [95% confidence interval {CI}] = 4.25 [2.13, 8.47], P < 0.001) and late HMR < 2.2 (OR [95% CI] = 2.06 [1.11, 3.83], P = 0.022). Elevated BMI was not significantly associated with low early and late HMR. The presence of abdominal obesity was significantly associated with low early and late HMR even in patients without elevated BMI values.
Abdominal obesity, but not general obesity, in HFpEF patients was independently associated with low HMR, suggesting that visceral fat may contribute to decreased cardiac sympathetic activity in patients with HFpEF.
UMIN000021831.
在射血分数保留的心力衰竭（HFpEF）患者中，一般肥胖或腹部肥胖（男性腰围≥85cm，女性腰围≥90cm）与心脏-纵隔比（HMR）之间的关系，HMR 是心脏去甲肾上腺素能神经支配的测量指标，与心脏碘-123-间碘苄胍闪烁显像（MIBG）之间的关系尚未明确。
共检查了 239 例同时具有 MIBG 和腹部周长数据的 HFpEF 患者。我们将这些患者分为腹部肥胖和非腹部肥胖患者。在心脏 MIBG 研究中，在注射后 15-20 分钟采集早期相图像，在早期相后 3 小时采集晚期相图像。使用低能型准直器获得的 HMR 转换为中能型准直器获得的 HMR。
腹部肥胖患者的早期和晚期 HMR 明显较低，尽管洗脱率没有明显差异。腹部肥胖患者中早期和晚期 HMR<2.2 的发生率明显更高。多元线性回归分析显示，腹部肥胖与早期 HMR（标准化β=-0.253，P=0.003）和晚期 HMR（标准化β=-0.222，P=0.010）独立相关。多元逻辑回归分析显示，腹部肥胖与早期 HMR<2.2（比值比[OR] [95%置信区间{CI}] = 4.25 [2.13，8.47]，P<0.001）和晚期 HMR<2.2（OR [95% CI] = 2.06 [1.11，3.83]，P=0.022）独立相关。升高的 BMI 与早期和晚期 HMR 降低无显著相关性。即使在 BMI 值不升高的患者中，腹部肥胖与早期和晚期 HMR 降低也显著相关。
HFpEF 患者的腹部肥胖而不是一般肥胖与 HMR 降低独立相关，提示内脏脂肪可能导致 HFpEF 患者心脏去甲肾上腺素能活性降低。
UMIN000021831。
