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THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
Rivista di Medicina Nucleare e Imaging Molecolare
A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the and to the International Research Group of Immunoscintigraphy
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index (SciSearch), Scopus
Impact Factor 2,413
The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2016 Apr 05
Sympathetic denervation in patients with ischemic cardiomyopathy and risk on ventricular tachy-arrhythmias. A pilot study
Walter NOORDZIJ 1, Arif ELVAN 2, Fatma DEMIREL 2, Piet JAGER 3, Rene TIO 4, Riemer SLART 1 ✉
1 Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands; 2 Department of Cardiology, Isala Hospital, Zwolle, The Netherlands; 3 Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands; 4 Department of Cardiology University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
BACKGROUND: Patients with ischemic cardiomyopathy (ICM) are at risk for ventricular arrhythmias and are protected by an implantable cardioverter defibrillator (ICD). Visualization of cardiac sympathetic innervation may play an additional role to left ventricular ejection fraction (LVEF) in identifying those patients who will benefit from ICD therapy. The purpose of this study was to detect the role of sympathetic denervation in the genesis of ventricular arrhythmias in ICM patients.
METHOD: 20 patients with ICM and LVEF < 30% were included in this pilot study. Included patients were equally stratified into two groups: no history of arrhythmias (group A) and recurrent arrhythmias (group B). All patients underwent cardiac sympathetic denervation (using carbon-11 labelled meta-hydroxy-ephedrine ([11C]-mHED)), myocardial ischemia and viability detection. Patients were followed up to one year after the imaging studies.
RESULTS: Mean age was 63 ± 7.5 years. Mean global retention of [11C]-mHED was 0.055 ± 0,012 min-1, and was not different between the two patient groups: 0.056 ± 0.011 min-1 vs 0.054 ± 0.013 min-1 for group A vs group B, respectively. During follow-up, seven patients developed ventricular arrhythmias, and four patients died. No difference in [11C]-mHED retention was found between patients with and without ventricular arrhythmia during follow up. However, size of denervated area was larger in patients who died during follow up: 10 ± 1 segments vs 6 ± 2 segments, p = 0.002.
CONCLUSIONS: Cardiac sympathetic innervation is impaired in patients with ischemic cardiomyopathy. All-cause mortality occurred in those patients with large areas of [11C]- mHED defect.