Circulation, Vol 89, 2843-2851, Copyright © 1994 by American Heart Association
WW Simmons, MR Freeman, EA Grima, TW Hsia and PW Armstrong
BACKGROUND: Increased activity of the sympathetic nervous system
contributes significantly to the pathophysiology of heart failure. However,
cardiac efferent sympathetic function has not been well characterized in
this disorder. In this study, we evaluated cardiac sympathetic innervation
using [123I]metaiodobenzylguanidine (MIBG) and compared this with left
ventricular (LV) tissue norepinephrine concentration and myocardial
perfusion, assessed by 201Tl, in a canine model of heart failure. METHODS
AND RESULTS: Planar and tomographic cardiac imaging was performed for MIBG
and 201Tl in 23 dogs: 8 normal dogs (group 1) and 15 dogs with heart
failure induced by right ventricular pacing at 250 beats per minute either
continuously for 3 weeks (group 2) or intermittently for 7 weeks (group 3).
Plasma and LV tissue norepinephrine concentrations were also measured.
Scintigraphic studies in group 2 demonstrated reduced cardiac MIBG activity
at heart failure (0.17 +/- 0.04 versus 0.29 +/- 0.05 counts per
megabecquerel per pixel at baseline, mean +/- SD; P = .0001), whereas
thallium activity was unchanged from baseline. This reduction in cardiac
MIBG activity with heart failure was associated with increased intraimage
variability in the distribution of MIBG activity (21 +/- 8% versus 13 +/-
7% at baseline, mean +/- SD; P = .0001). The MIBG heart-to-lung ratio was
calculated for all groups to control for the inhibitory effect that plasma
norepinephrine has on the neuronal uptake of MIBG. There was a positive
correlation between LV tissue norepinephrine and the MIBG heart-to-lung
ratio (r = .67; P < .001; n = 22), for which the group 2 heart failure
animals had the lowest values. No relation existed between plasma
norepinephrine concentration and the MIBG heart- to-lung ratio. In
addition, regional LV tissue norepinephrine concentration and MIBG activity
were both lowest at the apex in normal (group 1) and heart failure (group
2) dogs. The MIBG heart-to-lung ratio also correlated inversely with
cardiac filling pressure (r = - .59; P < .05) and heart rate (r = -.65;
P < .01) and positively with cardiac output (r = .53; P < .05).
CONCLUSIONS: Heart failure is associated with severe cardiac adrenergic
dysfunction manifested by reduced MIBG activity and increased heterogeneity
in the LV distribution of MIBG. Furthermore, MIBG scintigraphy is a simple
noninvasive method for assessing global and regional LV tissue
norepinephrine levels.
ARTICLES
Abnormalities of cardiac sympathetic function in pacing-induced heart failure as assessed by [123I]metaiodobenzylguanidine scintigraphy
Department of Medicine, St Michael's Hospital, University of Toronto, Ontario, Canada.
This article has been cited by other articles:
 |
|
 |
|
  T. Tsutamoto, K. Nishiyama, H. Sakai, T. Tanaka, M. Fujii, T. Yamamoto, M. Yamaji, and M. Horie Transcardiac increase in norepinephrine and prognosis in patients with chronic heart failure Eur J Heart Fail, December 1, 2008; 10(12): 1208 - 1214. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Kurata, A. Uehara, and A. Ishikawa Improvement of Cardiac Sympathetic Innervation by Renal Transplantation J. Nucl. Med., July 1, 2004; 45(7): 1114 - 1120. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Sato, K. Maehara, H. Yaoita, H. Otani, A. Hirosaka, T. Saito, N. Onuki, N. Komatsu, T. Ishihata, and Y. Maruyama Correlation Between Cardiac Norepinephrine Overflow During Exercise and Cardiac 123I-MIBG Uptake in Patients with Chronic Heart Failure J. Nucl. Med., October 1, 2003; 44(10): 1618 - 1624. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kasama, T. Toyama, H. Kumakura, Y. Takayama, S. Ichikawa, T. Suzuki, and M. Kurabayashi Spironolactone Improves Cardiac Sympathetic Nerve Activity and Symptoms in Patients with Congestive Heart Failure J. Nucl. Med., October 1, 2002; 43(10): 1279 - 1285. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kasama, T. Toyama, H. Hoshizaki, S. Oshima, K. Taniguchi, T. Suzuki, and M. Kurabayashi Dobutamine Gated Blood Pool Scintigraphy Predicts the Improvement of Cardiac Sympathetic Nerve Activity, Cardiac Function, and Symptoms After Treatment in Patients With Dilated Cardiomyopathy* Chest, August 1, 2002; 122(2): 542 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Merlet, L. Hittinger, J. L. Dubois-Rande, and A. Castaigne Myocardial Adrenergic Dysinnervation in Dilated Cardiomyopathy: Cornerstone or Epiphenomenon? J. Nucl. Med., April 1, 2002; 43(4): 536 - 539. [Full Text] [PDF]
|
|
|
|
 |
|
 E.N Simantirakis, V.K Prassopoulos, S.I Chrysostomakis, G.E Kochiadakis, S.I Koukouraki, J.P Lekakis, N.S Karkavitsas, and P.E Vardas Effects of asynchronous ventricular activation on myocardial adrenergic innervation in patients with permanent dual-chamber pacemakers. An I123-metaiodobenzylguanidine cardiac scintigraphic study Eur. Heart J., February 2, 2001; 22(4): 323 - 332. [Abstract] [PDF]
|
|
|
|
 |
|
 A. A. Young, S. Dokos, K. A. Powell, B. Sturm, A. D. McCulloch, R. C. Starling, P. M. McCarthy, and R. D. White Regional heterogeneity of function in nonischemic dilated cardiomyopathy Cardiovasc Res, February 1, 2001; 49(2): 308 - 318. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Mullenheim, B. Preckel, D. Obal, M. Heiderhoff, J. Hoff, V. Thamer, and W. Schlack Left Stellate Ganglion Block Has Only Small Effects on Left Ventricular Function in Awake Dogs Before and After Induction of Heart Failure Anesth. Analg., October 1, 2000; 91(4): 787 - 792. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Igawa, T. Nozawa, N. Yoshida, N. Fujii, M. Inoue, S. Tazawa, H. Asanoi, and H. Inoue Heterogeneous cardiac sympathetic innervation in heart failure after myocardial infarction of rats Am J Physiol Heart Circ Physiol, April 1, 2000; 278(4): H1134 - H1141. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Cohen-Solal, Y. Esanu, D. Logeart, F. Pessione, C. Dubois, G. Dreyfus, R. Gourgon, and P. Merlet Cardiac metaiodobenzylguanidine uptake in patients with moderate chronic heart failure: relationship with peak oxygen uptake and prognosis J. Am. Coll. Cardiol., March 1, 1999; 33(3): 759 - 766. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F Hartmann, S Ziegler, S Nekolla, M Hadamitzky, M Seyfarth, G Richardt, and M Schwaiger Regional patterns of myocardial sympathetic denervation in dilated cardiomyopathy: an analysis using carbon-11 hydroxyephedrine and positron emission tomography Heart, March 1, 1999; 81(3): 262 - 270. [Abstract] [Full Text]
|
|
|
|
 |
|
 T. Nozawa, A. Igawa, N. Yoshida, M. Maeda, M. Inoue, Y. Yamamura, H. Asanoi, and H. Inoue Dual-Tracer Assessment of Coupling Between Cardiac Sympathetic Neuronal Function and Downregulation of ß-Receptors During Development of Hypertensive Heart Failure of Rats Circulation, June 16, 1998; 97(23): 2359 - 2367. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ungerer, F. Hartmann, M. Karoglan, A. Chlistalla, S. Ziegler, G. Richardt, M. Overbeck, H. Meisner, A. Schomig, and M. Schwaiger Regional In Vivo and In Vitro Characterization of Autonomic Innervation in Cardiomyopathic Human Heart Circulation, January 20, 1998; 97(2): 174 - 180. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Rundqvist, G. Eisenhofer, M. Elam, and P. Friberg Attenuated Cardiac Sympathetic Responsiveness During Dynamic Exercise in Patients With Heart Failure Circulation, February 18, 1997; 95(4): 940 - 945. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. D. Sackner-Bernstein and D. M. Mancini Rationale for Treatment of Patients With Chronic Heart Failure With Adrenergic Blockade JAMA, November 8, 1995; 274(18): 1462 - 1467. [Abstract] [PDF]
|
|