心力衰竭和射血分数降低患者的神经代谢和心室失同步。
Neurometabolism and Ventricular Dyssynchrony in Patients With Heart Failure and Reduced Ejection Fraction.
机构信息
Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China.
出版信息
J Am Coll Cardiol. 2022 Nov 15;80(20):1884-1896. doi: 10.1016/j.jacc.2022.08.801.
BACKGROUND
The brain coordinates the heart through the autonomic nervous system (ANS). Numerous mediator signals along the brain-heart axis interact with the neuronal-metabolic system in heart failure (HF). Disturbances in cardio-neural interactions influence the disease progression in patients with HF.
OBJECTIVES
The purpose of this study was to investigate the interactome between ANS-associated neurometabolism and ventricular dyssynchrony in patients with heart failure with reduced ejection fraction (HFrEF). Further, we studied the association of neurometabolism with major arrhythmic events (MAEs).
METHODS
A total of 197 patients with HFrEF who underwent gated single-photon emission computed tomography myocardial perfusion imaging and the brain F-fluorodeoxyglucose positron emission tomography/computed tomography were prospectively enrolled. Relationships between the brain metabolism and MAEs were assessed using Cox models and mediation analyses. Finally, metabolic central autonomic networks were constructed and statistically compared between patients with and without MAEs.
RESULTS
In total, 35 (17.8%) patients experienced MAEs during a median follow-up of 3.1 years. In patients with HFrEF (age 58 years [IQR: 50-64 years], left ventricular ejection fraction: 20.0% [IQR: 15.0%-25.0%]), glucose hypometabolism in the insula, hippocampus, amygdala, cingulate gyrus, and caudate nucleus were independent predictors for MAEs (all P < 0.05). Cerebral hypometabolism was related to ventricular dyssynchrony, which was the predominant risk factor of MAEs. Additionally, patients who experienced MAEs presented hypoconnectivity in the metabolic central autonomic network compared with those without MAEs (P < 0.05).
CONCLUSIONS
We found an interaction of the neuronal metabolic-ventricular dyssynchronization axis in HF, which might be related to MAEs. This new brain-heart axis could expand our understanding of the distinct pathomechanisms of HFrEF.
背景
大脑通过自主神经系统（ANS）协调心脏。沿脑心轴的许多介质信号与心力衰竭（HF）中的神经元代谢系统相互作用。心脏神经相互作用的紊乱会影响 HF 患者的疾病进展。
目的
本研究旨在探讨自主神经相关神经代谢与射血分数降低的心力衰竭（HFrEF）患者心室不同步之间的相互作用。此外，我们还研究了神经代谢与主要心律失常事件（MAEs）的相关性。
方法
前瞻性纳入 197 例 HFrEF 患者，行门控单光子发射计算机断层心肌灌注显像和脑 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描。使用 Cox 模型和中介分析评估大脑代谢与 MAEs 之间的关系。最后，构建代谢性中枢自主神经网络，并对有和无 MAEs 的患者进行统计学比较。
结果
在中位随访 3.1 年期间，共有 35 例（17.8%）患者发生 MAEs。在 HFrEF 患者（年龄 58 岁[IQR：50-64 岁]，左心室射血分数：20.0%[IQR：15.0%-25.0%]）中，岛叶、海马、杏仁核、扣带回和尾状核的葡萄糖代谢低下是 MAEs 的独立预测因子（均 P<0.05）。大脑代谢低下与心室不同步有关，而心室不同步是 MAEs 的主要危险因素。此外，与无 MAEs 的患者相比，发生 MAEs 的患者代谢性中枢自主神经网络的连接性降低（P<0.05）。
结论
我们发现 HF 中心神经元代谢-心室不同步轴存在相互作用，可能与 MAEs 有关。这个新的脑-心轴可以扩展我们对 HFrEF 不同发病机制的理解。
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