在没有左心室容量或压力超负荷的心力衰竭患者中，心肌肾上腺素能神经活动增强。

Myocardial adrenergic nervous activity is intensified in patients with heart failure without left ventricular volume or pressure overload.

作者信息

Imamura Y, Ando H, Ashihara T, Fukuyama T

机构信息

Department of Cardiology, Matsuyama Red Cross Hospital, Japan.

出版信息

J Am Coll Cardiol. 1996 Aug;28(2):371-5. doi: 10.1016/0735-1097(96)00165-9.

DOI:10.1016/0735-1097(96)00165-9

PMID:8800112

Abstract

OBJECTIVES

To clarify whether myocardial adrenergic activity is different in patients with heart failure without left ventricular volume or pressure overload, we used iodine-123 metaiodobenzylguanidine (MIBG) imaging to study patients with mitral stenosis.

BACKGROUND

In patients with heart failure due to cardiomyopathy or to valve diseases with volume or pressure overload, or both, myocardial adrenergic nerve activity is accelerated independent of underlying cause. However, it is not clear whether this change in myocardial adrenergic nerve activity is present in patients without left ventricular volume or pressure overload.

METHODS

The study patients were 20 men and women with normal left ventricular function and heart failure due to mitral stenosis. Planar MIBG images obtained from these patients were compared with images from nine age-matched healthy subjects (control group). Myocardial uptake of MIBG was calculated as the heart/mediastinal activity ratio. Storage and release of MIBG were calculated as percent myocardial MIBG washout from 15 min to 4 h after isotope injection. All 20 study patients underwent echocardiography, and 16 underwent right heart catheterization.

RESULTS

The heart/mediastinal activity ratio in the immediate images (15 min) did not show any significant difference between the patient and control groups. Myocardial washout was increased in patients with severe heart failure. The level of myocardial washout correlated with left atrial diameter (r = 0.51, p = 0.02) and mitral valve area calculated with Doppler echocardiography (r = -0.61, p < 0.01) and mitral valve area calculated with cardiac catheterization (r = -0.62, p = 0.02). The closest correlation existed between myocardial washout and cardiac output (r = -0.80, p < 0.01).

CONCLUSIONS

In heart failure due to mitral stenosis, myocardial adrenergic nerve activity is intensified. A decrease in cardiac output associated with mitral stenosis acts as a potent stimulus for this intensification.

摘要

目的

为了阐明在没有左心室容量或压力超负荷的心力衰竭患者中，心肌肾上腺素能活性是否存在差异，我们使用碘-123间碘苄胍（MIBG）显像对二尖瓣狭窄患者进行了研究。

背景

在因心肌病或伴有容量或压力超负荷或两者兼具的瓣膜疾病导致心力衰竭的患者中，心肌肾上腺素能神经活性会加速，且与潜在病因无关。然而，目前尚不清楚在没有左心室容量或压力超负荷的患者中是否存在这种心肌肾上腺素能神经活性的变化。

方法

研究对象为20名左心室功能正常且因二尖瓣狭窄导致心力衰竭的男性和女性。将这些患者的平面MIBG图像与9名年龄匹配的健康受试者（对照组）的图像进行比较。MIBG的心肌摄取量通过心脏/纵隔活性比值计算得出。MIBG的储存和释放通过同位素注射后15分钟至4小时内心肌MIBG清除率的百分比来计算。所有20名研究患者均接受了超声心动图检查，其中16名接受了右心导管检查。

结果

即时图像（15分钟）中的心脏/纵隔活性比值在患者组和对照组之间未显示出任何显著差异。严重心力衰竭患者的心肌清除率增加。心肌清除率水平与左心房直径（r = 0.51，p = 0.02）、通过多普勒超声心动图计算的二尖瓣面积（r = -0.61，p < 0.01）以及通过心导管检查计算的二尖瓣面积（r = -0.62，p = 0.02）相关。心肌清除率与心输出量之间的相关性最为密切（r = -0.80，p < 0.01）。