Kondo Takumi, Seo Masahiro, Watanabe Tetsuya, Yamada Takahisa, Morita Takashi, Kawasaki Masato, Kikuchi Atsushi, Kawai Tsutomu, Nishimoto Yuji, Nakamura Jun, Fujita Takeshi, Tanichi Masanao, Chang Yongchol, Sakata Yasushi, Fukunami Masatake
Division of Cardiology, Osaka General Medical Center, Osaka, 558-8558, Japan.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan.
Eur J Nucl Med Mol Imaging. 2025 Feb;52(3):1060-1072. doi: 10.1007/s00259-024-06934-0. Epub 2024 Oct 22.
Remote ischemic periconditioning (RIPC) has demonstrated cardioprotective effects and improved clinical outcomes as an adjunct to emergent percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). However, whether RIPC affects the cardiac sympathetic nerve activity in patients with STEMI remains unclear. This study investigated the effects of RIPC on cardiac sympathetic nerve activity in patients with STEMI.
We prospectively assigned patients with STEMI who underwent emergent PCI to receive RIPC or no procedure (control group) upon arrival at the cardiac catheterization laboratory. The primary endpoint was cardiac sympathetic nerve activity assessed through the washout rate (WR) in cardiac I-metaiodobenzylguanidine (I-MIBG) imaging.
Patients in the RIPC (n = 62) and control (n = 60) groups had similar demographic and clinical characteristics at baseline. Multivariable linear regression models revealed that the culprit lesion of the left anterior descending artery and hemoglobin level were significantly and independently associated with WR at discharge. WRs of the groups differed insignificantly at discharge. However, the RIPC group (n = 49) showed significantly lower WR than the control group (n = 47) at 1 year after discharge (p = 0.027). In the single-photon emission computed tomography analysis at 1 year after discharge, the RIPC group demonstrated significantly higher late uptake (p = 0.021) and lower WR (p = 0.013) in the nonculprit lesion, with a non-significant decrease in WR for the culprit lesion.
RIPC can suppress augmented cardiac sympathetic nerve activity in patients with STEMI, particularly in nonculprit lesions.
远程缺血预处理（RIPC）已被证明具有心脏保护作用，并能改善临床结局，作为ST段抬高型心肌梗死（STEMI）患者紧急经皮冠状动脉介入治疗（PCI）的辅助手段。然而，RIPC是否影响STEMI患者的心脏交感神经活动仍不清楚。本研究调查了RIPC对STEMI患者心脏交感神经活动的影响。
我们前瞻性地将接受紧急PCI的STEMI患者分配为在到达心导管实验室时接受RIPC或不进行任何操作（对照组）。主要终点是通过心脏间碘苄胍（I-MIBG）显像中的清除率（WR）评估的心脏交感神经活动。
RIPC组（n = 62）和对照组（n = 60）患者在基线时具有相似的人口统计学和临床特征。多变量线性回归模型显示，左前降支罪犯病变和血红蛋白水平与出院时的WR显著且独立相关。两组出院时的WR差异无统计学意义。然而，出院后1年时，RIPC组（n = 49）的WR显著低于对照组（n = 47）（p = 0.027）。在出院后1年的单光子发射计算机断层扫描分析中，RIPC组在非罪犯病变中显示出显著更高的晚期摄取（p = 0.021）和更低的WR（p = 0.013），罪犯病变的WR下降不显著。
RIPC可抑制STEMI患者增强的心脏交感神经活动，尤其是在非罪犯病变中。
