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A Journal on Nuclear Medicine and Molecular Imaging
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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2004 March;48(1):20-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Sympathetic nervous function in patients with hypertrophic cardiomyopathy assessed by [123I]-MIBG: relationship with left ventricular perfusion and function

Pace L. 1, 2, Betocchi S. 3, Losi M. A. 3, Della Morte A. M. 1, Ciampi Q. 3, Nugnez R. 1, Chiariello M. 3, Salvatore M. 1, 2

1 Department of Biomorphologic and Functional Sciences “Federico II” University, Naples, Italy 2 I.B.B. of National Council for Researches, Naples, Italy 3 Department of Medicine, Cardiovascular and Immunological Sciences “Federico II” University, Naples, Italy


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Aim. The aim of the ­present ­study was to eval­u­ate
[123I] ­MIBG ­uptake and clear­ance in ­patients ­with hyper­troph­ic car­di­om­yo­pa­thy (HCM) and to ­assess ­their rela­tion­ships ­with ­left ven­tric­u­lar func­tion (sys­tol­ic and dia­stol­ic) and per­fu­sion.
Methods. Eleven con­sec­u­tive ­patients ­with HCM (8 men and 3 wom­en; ­mean age 38±12 ­years, ­none in the dilat­ed ­phase) under­went (in sep­ar­ate ­days, in ran­dom ­order) [123 I]-­MIBG scin­tig­ra­phy, [99mTc]-­MIBI ­SPET at ­rest, and ech­o­car­di­og­ra­phy. All ­patients ­were stud­ied in fast­ing con­di­tion, and all med­i­ca­tions ­were dis­con­tin­ued. [99mTc]-­MIBI ­SPET ­study was per­formed 1 ­hour ­after trac­er injec­tion. [123I]-­MIBG ­study was ­acquired 5 min­utes (pla­nar) and 4 ­hours (pla­nar and ­SPET) ­after the i.v. injec­tion of [123I]-­MIBG. Heart to med­i­as­ti­num ­ratio (H/M) was com­put­ed at 4 ­hours. Wash out ­rate (WOR) was com­put­ed as: (H ear­ly - H ­delayed)/(H ear­ly), ­after ­decay cor­rec­tion. Both [123I]-­MIBG and [99mTc]-­MIBI ­SPET ­were ana­lyzed on 3 ­short ­axis ­views (api­cal, mid­dle, and ­basal). Left ven­tric­u­lar out­flow ­tract gra­di­ent (LVOTG), ejec­tion frac­tion, vol­umes, sep­tum thick­ness, and ­left atri­al frac­tion­al short­en­ing (­LAFS) ­were eval­u­at­ed on ech­o­car­di­og­ra­phy.
Results. [123I]-­MIBG WOR ­showed a pos­i­tive rela­tion­ship ­with ­LVOTG (r=0.84, p<0.001) and sep­tum thick­ness (r=0.76, p<0.01), ­while a neg­a­tive one was ­found ­with ­LAFS (r=-0.66, p<0.05). The ­study ­group was divid­ed ­into: Group A (n=5) ­with high­er, and Group B (n=6) ­with low­er WOR ­than the ­median val­ue (i.e. 11%). Group A ­patients had sig­nif­i­cant­ly low­er ­LAFS (17.6±4.8 vs 26.8±7.2%, p<0.05), high­er ­LVOTG (49±35 vs 3±3 mmHg), and thick­er sep­tum (21±2 vs 17±2 mm) ­than Group B ­patients. Inferior and sep­tal ­wall [123I]-­MIBG ­uptake on 4 ­hour ­SPET was sig­nif­i­cant­ly low­er in Group A ­than in Group B. On the oth­er ­hand, no dif­fer­enc­es ­were ­found in 99mT-­MIBI ­SPET ­rest region­al ­uptake ­between the 2 sub­groups of ­patients.
Conclusion. These ­results sug­gest ­that car­diac sym­pa­thet­ic activ­ity cor­re­lates to car­diac anat­o­my (i.e. ­degree of hyper­tro­phy) and dia­stol­ic func­tion in ­patients ­with HCM.

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