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(Circulation. 2000;101:2579.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Extent of Cardiac Sympathetic Neuronal Damage Is Determined by the Area of Ischemia in Patients With Acute Coronary Syndromes

Ichiro Matsunari, MD; Ullrich Schricke, MD; Frank M. Bengel, MD; Hans-Ullrich Haase, MD; Petra Barthel, MD; Georg Schmidt, MD; Stephan G. Nekolla, PhD; Albert Schoemig, MD; Markus Schwaiger, MD

From Nuklearmedizinische Klinik und Poliklinik (I.M., U.S., F.M.B., S.G.N., M.S.) and 1. Medizinische Klinik, Technische Universität München, Klinikum rechts der Isar (H.-U.H., P.B., G.S., A.S.), Munich, Germany. Dr Matsunari is currently at the Medical and Pharmacological Research Center Foundation, Ishikawa, Japan.

Correspondence to Markus Schwaiger, MD, Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Klinikum rechts der Isar, Ismaninger Str 22, 81675 München, Germany.

Background—Prior studies have demonstrated that acute ischemic injury causes sympathetic neuronal damage exceeding the area of necrosis. The aim of this study was to test the hypothesis that sympathetic neuronal damage measured by ¹²³I-metaiodobenzylguanidine (MIBG) imaging would be determined by the area of ischemia as reflected by area at risk in patients undergoing reperfusion therapy for acute coronary syndromes.

Methods and Results—In 12 patients, the myocardium at risk was assessed by ^99mTc-sestamibi SPECT before reperfusion, and infarct size was measured by follow-up ^99mTc-sestamibi SPECT 1 week later. All patients also underwent ¹²³I-MIBG SPECT within a mean of 11 days after onset. The SPECT image analysis was based on a semiquantitative polar map approach. Defect size on the ¹²³I-MIBG or ^99mTc-sestamibi SPECT was measured for the left ventricle (LV) with the use of a threshold of -2.5 SD from the mean value of a normal database and was expressed as %LV. The ¹²³I-MIBG defect size (47±18%LV) was larger than the infarct size (27±23%LV, P<0.001) but was similar to the risk area (49±18%LV, P=NS). Furthermore, the ¹²³I-MIBG defect size was closely correlated with the risk area (r=0.905, P<0.001).

Conclusions—Sympathetic neuronal damage measured by ¹²³I-MIBG SPECT is larger than infarct size and is closely related to risk area, suggesting high sensitivity of neuronal structures to ischemia compared with myocardial cells.

Key Words: nervous system, autonomic • coronary disease • tomography

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