Relationships between left ventricular sympathetic innervation and diastolic dysfunction: the role of myocardial innervation/perfusion mismatch

• Published in: Journal of nuclear cardiology 2018-08, Vol.25 (4), p.1101-1109
• Main Authors: Gimelli, Alessia, Liga, Riccardo, Avogliero, Francesco, Coceani, Michele, Marzullo, Paolo
• Format: Article
• Language: English
• Subjects: 123I-metaiodobenzylguanidine; 3-Iodobenzylguanidine; Aged; Aged, 80 and over; Cadmium; Cameras; Cardiology; Cardiovascular disease; CZT; Diastole - physiology; Diastolic dysfunction; Dual-isotope SPECT; Female; Heart failure; Heart Ventricles - innervation; Humans; Hypertension; Imaging; Innervation/perfusion mismatch; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial Perfusion Imaging; Nuclear Medicine; Original Article; Patients; Peak filling rate; Radiology; Sympathetic Nervous System - physiology; Ventricular Dysfunction, Left - etiology; Ventricular Function, Left
• ISSN: 1071-3581; 1532-6551
• DOI: 10.1007/s12350-016-0753-3

A possible relationship between cardiac sympathetic denervation and left ventricular (LV) diastolic dysfunction has been suggested. However, an evaluation of the interactions between myocardial adrenergic tone and LV perfusion and diastolic function is lacking. Seventy-two patients underwent 99mTc-tetrofosmin/123I-metaiodobenzylguanidine (123I-MIBG) cardiac Cadmium-Zinc-Telluride (CZT) imaging. The summed rest score (SRS) and summed 123I-MIBG score (SS-MIBG) were computed as measures of regional perfusion and innervation heterogeneities. LV segments showing an impaired innervation, despite a relatively preserved perfusion (99mTc-tetrofosmin-123I-MIBG tracers’ uptake ≥25%), were individuated (innervation/perfusion mismatch). The peak filling rate (PFR) was computed as a measure of LV diastolic function. Nineteen of the 72 (26%) patients presented a normal LV diastolic function, while 29 (40%) and 24 (34%) had a mild and overt diastolic dysfunction. Subjects with diastolic dysfunction showed more abnormal SRS and SS-MIBG values (P < 0.001). In the global population, 502/1224 (41%) LV segments showed an innervation/perfusion mismatch. A modest correlation between the extent of cardiac innervation/perfusion mismatch and PFR values was evident (R = −0.27, P = 0.029). On multivariate analysis, the extent of regional innervation/perfusion mismatch remained an independent predictor of overt LV diastolic abnormalities (P = 0.017). The burden of LV regions showing an innervation/perfusion mismatch associates with the occurrence of overt diastolic dysfunction.