Egi Ryuta, Fukushima Kenji, Matsusaka Yohji, Yamane Tomohiko, Seto Akira, Matsunari Ichiro, Nakajima Yoshie, Nakano Shintaro, Kuji Ichiei
Department of Nuclear Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.
Ann Nucl Cardiol. 2024;10(1):6-15. doi: 10.17996/anc.23-00008. Epub 2024 Oct 31.
: While the non-invasive assessment of cardiac sympathetic nerve dysfunction is readily accessible, its applicability in invasive intervention for structural heart disease has received limited investigation. Our study aimed to clarify the cardiac sympathetic nerve function in patients with severe Aortic stenosis (AS) and its postoperative changes after transcatheter aortic valve implantation (TAVI) using I-metaiodobenzylguanidine scintigraphy (MIBG) in combination with 5-year mortality prediction model. : Consecutive 26 patients (83±5ys, male 4) with severe AS who underwent MIBG prior TAVI procedures were retrospectively enrolled. Of those, 15 patients underwent postoperative-follow up MIBG. The early and delayed heart-to-mediastinum ratio (e- and d-H/M), and washout rate (WR) were obtained from MIBG planner imaging. The MIBG 5-year mortality prediction model was employed to compare pre and after TAVI. Cardiac function and wall thickness were evaluated with transthoracic echocardiography. : Preoperative e-H/M, d-H/M, and WR were 2.4±0.5, 2.3±0.4, and 29±14% respectively, and WR showed significant correlation to left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) (r=-0.4 and 0.6; p=0.03, and 0.001 for LVEF and BNP, respectively). 102±28 days after TAVI, either H/M or WR did not show significant improvement among enrolled patients (2.5±0.3, 2.3±0.4, and 30±11% for e-, d-H/M, and WR for after TAVI), while the BNP level was significantly reduced (128±691 and 94±194 pg/dl, for pre vs. after, p=0.008). Five patients showed a significant recovery in WR (37.0±13.8 and 28.8±8.5% for pre and post, p=0.04), and left ventricular wall thickness was significantly thinner compared to those who did not recover (15.2±3.2 vs 11.2±2.4, p=0.02; 14.2±2.9 vs 10.8±1.8, p=0.02 for intraventricular septum and posterior wall, respectively). In 5-year prediction risk model, 7 patients showed a significant reduction in mortality risk, and the patients who did not show risk reduction had significantly reduced renal function (eGFR 57.5±18.8 vs. 38.2±11.3 ml/min/1.73m, p=0.03 for recovered vs. not recovered). : After a 3-month follow-up after TAVI, diverse response in cardiac MIBG parameters were observed among patients with severe AS, despite successful valve replacement. Cardiac MIBG serves as a non-invasive tool that can comprehensively evaluate and surrogate the severity of heart failure resulting from a multi-factorial condition.
虽然心脏交感神经功能障碍的非侵入性评估方法容易获得,但其在结构性心脏病侵入性干预中的适用性研究有限。我们的研究旨在使用碘-间位碘代苄胍闪烁显像(MIBG)结合5年死亡率预测模型,阐明重度主动脉瓣狭窄(AS)患者的心脏交感神经功能及其经导管主动脉瓣植入术(TAVI)后的变化。:回顾性纳入26例在TAVI手术前接受MIBG检查的重度AS患者(年龄83±5岁,男性4例)。其中,15例患者接受了术后随访MIBG检查。从MIBG平面显像中获取早期和延迟的心-纵隔比值(e-和d-H/M)以及洗脱率(WR)。采用MIBG 5年死亡率预测模型比较TAVI前后的情况。通过经胸超声心动图评估心脏功能和心室壁厚度。:术前e-H/M、d-H/M和WR分别为2.4±0.5、2.3±0.4和29±14%,WR与左心室射血分数(LVEF)和脑钠肽(BNP)显著相关(与LVEF和BNP的r分别为-0.4和0.6;p分别为0.03和0.001)。TAVI后102±28天,纳入研究的患者中H/M或WR均未显示出显著改善(TAVI后e-、d-H/M和WR分别为2.5±0.3、2.3±0.4和30±11%),而BNP水平显著降低(术前与术后分别为128±691和94±194 pg/dl,p=0.008)。5例患者的WR有显著恢复(术前与术后分别为37.0±13.8和28.8±8.5%,p=0.04),与未恢复的患者相比,左心室壁厚度显著变薄(室间隔分别为15.2±3.2 vs 11.2±2.4,p=0.02;后壁分别为14.2±2.9 vs 10.8±1.8,p=0.02)。在5年预测风险模型中,7例患者的死亡风险显著降低,未显示风险降低的患者肾功能显著下降(恢复组与未恢复组的估算肾小球滤过率分别为57.5±18.8 vs. 38.2±11.3 ml/min/1.73m²,p=0.03)。:TAVI术后3个月随访发现,重度AS患者尽管瓣膜置换成功,但心脏MIBG参数存在不同反应。心脏MIBG可作为一种非侵入性工具,全面评估和替代多因素导致的心力衰竭严重程度。