Alessia Gimelli1, Riccardo Liga2, Francesca Menichetti3, Ezio Soldati3, Maria Grazia Bongiorni3, Paolo Marzullo4,5. 1. Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy. gimelli@ftgm.it. 2. University of Pisa, Pisa, Italy. 3. Cardio-Thoracic and Vascular department, University Hospital of Pisa, Pisa, Italy. 4. Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy. 5. CNR, Institute of Clinical Physiology, Pisa, Italy.
Abstract
BACKGROUND: A correlation between left ventricular (LV) dyssynchrony (LVD) and impaired myocardial sympathetic tone has been hypothesized. We sought to assess the interactions between regional LV sympathetic innervation, perfusion, and mechanical dyssynchrony. METHODS: Eighty-three patients underwent evaluation of LV perfusion and sympathetic innervation on 99mTc-tetrofosmin/123I-metaiodobenzylguanidine (123I-MIBG) imaging. The summed rest score and summed 123I-MIBG score (SS-MIBG) were computed. The extent of "innervation/perfusion" mismatch was defined as the number of denervated LV segments with relatively preserved perfusion. LVD was evaluated on phase analysis and the wall with latest mechanical activation identified. RESULTS: LVD was revealed in 36 (43%) patients. Patients with LVD had more abnormal values of SRS (21 ± 9 vs 10 ± 8, P < 0.001) and SS-MIBG (29 ± 9 vs 17 ± 11, P < 0.001) than those without LVD. The presence of LVD also clustered with a higher burden of "innervation/perfusion" mismatch (P = 0.019). On per-wall analysis, LV walls with delayed mechanical activation showed a higher burden of "innervation/perfusion" mismatch (2.3 ± 1.4 segments) than normally contracting walls (1.3 ± 1.2 segments; P < 0.001). On multivariate analysis, the extent of "innervation/perfusion" mismatch was the only predictor of delayed mechanical activation (P = 0.029). CONCLUSIONS: Patients with LVD show an elevated burden of "innervation/perfusion" mismatch that is concentrated at the level of the most dyssynchronous walls.
BACKGROUND: A correlation between left ventricular (LV) dyssynchrony (LVD) and impaired myocardial sympathetic tone has been hypothesized. We sought to assess the interactions between regional LV sympathetic innervation, perfusion, and mechanical dyssynchrony. METHODS: Eighty-three patients underwent evaluation of LV perfusion and sympathetic innervation on 99mTc-tetrofosmin/123I-metaiodobenzylguanidine (123I-MIBG) imaging. The summed rest score and summed 123I-MIBG score (SS-MIBG) were computed. The extent of "innervation/perfusion" mismatch was defined as the number of denervated LV segments with relatively preserved perfusion. LVD was evaluated on phase analysis and the wall with latest mechanical activation identified. RESULTS: LVD was revealed in 36 (43%) patients. Patients with LVD had more abnormal values of SRS (21 ± 9 vs 10 ± 8, P < 0.001) and SS-MIBG (29 ± 9 vs 17 ± 11, P < 0.001) than those without LVD. The presence of LVD also clustered with a higher burden of "innervation/perfusion" mismatch (P = 0.019). On per-wall analysis, LV walls with delayed mechanical activation showed a higher burden of "innervation/perfusion" mismatch (2.3 ± 1.4 segments) than normally contracting walls (1.3 ± 1.2 segments; P < 0.001). On multivariate analysis, the extent of "innervation/perfusion" mismatch was the only predictor of delayed mechanical activation (P = 0.029). CONCLUSIONS:Patients with LVD show an elevated burden of "innervation/perfusion" mismatch that is concentrated at the level of the most dyssynchronous walls.
Entities:
Keywords:
123I-metaiodobenzylguanidine; CZT; innervation/perfusion mismatch; left ventricular dyssynchrony; phase analysis
Authors: Mark J Boogers; C Jan Willem Borleffs; Maureen M Henneman; Rutger J van Bommel; Jan van Ramshorst; Eric Boersma; Petra Dibbets-Schneider; Marcel P Stokkel; Ernst E van der Wall; Martin J Schalij; Jeroen J Bax Journal: J Am Coll Cardiol Date: 2010-06-15 Impact factor: 24.094
Authors: Yong-Mei Cha; Panithaya Chareonthaitawee; Ying-Xue Dong; Bradley J Kemp; Jae K Oh; Chinami Miyazaki; David L Hayes; Robert F Rea; Samuel J Asirvatham; Tracy L Webster; Connie M Dalzell; David O Hodge; Regina M Herges; Yan-Zhong Yong; Yanhua Zhang; Peng-Sheng Chen Journal: Circ Heart Fail Date: 2011-03-18 Impact factor: 8.790
Authors: James A Fallavollita; Brendan M Heavey; Andrew J Luisi; Suzanne M Michalek; Sunil Baldwa; Terry L Mashtare; Alan D Hutson; Robert A Dekemp; Michael S Haka; Munawwar Sajjad; Thomas R Cimato; Anne B Curtis; Michael E Cain; John M Canty Journal: J Am Coll Cardiol Date: 2013-09-25 Impact factor: 24.094
Authors: Jeroen J Bax; Gabe B Bleeker; Thomas H Marwick; Sander G Molhoek; Eric Boersma; Paul Steendijk; Ernst E van der Wall; Martin J Schalij Journal: J Am Coll Cardiol Date: 2004-11-02 Impact factor: 24.094
Authors: Anna I Mishkina; Victor V Saushkin; Tariel A Atabekov; Svetlana I Sazonova; Vladimir V Shipulin; Samia Massalha; Roman E Batalov; Sergey V Popov; Konstantin V Zavadovsky Journal: J Nucl Cardiol Date: 2022-07-14 Impact factor: 3.872