Regional interaction between myocardial sympathetic denervation, contractile dysfunction, and fibrosis in heart failure with preserved ejection fraction: 11C- hydroxyephedrine PET study
Regional interaction between myocardial sympathetic denervation, contractile dysfunction, and fibrosis in heart failure with preserved ejection fraction: 11C- hydroxyephedrine PET study
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DOI：
10.1007/s00259-017-3760-y
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发表时间：
2017-10-01
影响因子：
9.1
通讯作者：
Tamaki, Nagara
中科院分区：
文献类型：
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作者：
Aikawa, Tadao;Naya, Masanao;Tamaki, Nagara
目的 本研究旨在通过 (11)C 羟基麻黄碱 (HED) 正电子发射断层扫描 (PET) 量化左心室射血分数 (HFpEF) 心力衰竭患者的区域交感神经去神经支配的显着预测因素。 方法 研究纳入 34 名患有 HFpEF（左心室射血分数 >= 40%）的患者（年龄 63 +/- 15 岁，23 名男性）和11 名年龄匹配的志愿者，没有心力衰竭。进行心脏磁共振成像来测量左心室的大小和功能，以及心肌晚期钆增强（LGE）的程度。进行 11C-HED PET 来量化心肌交感神经支配，以 11C-HED 保留指数（RI，%/ 分钟）表示。为了确定 HFpEF 患者局部 11C-HED RI 的预测因素，我们提出了一个多变量混合效应模型，用于使用非结构化协方差矩阵对各个节段进行重复测量。结果 HFpEF 患者的整体 11C-HED RI 显着低于志愿者，并且异质性更强（所有 P < 0.01）。区域 11C-HED RI 与收缩期壁增厚呈正相关（r = 0.42，P < 0.001），与 LGE 范围呈负相关（r = -0.43，P < 0.001）。 HFpEF 患者中具有大范围 LGE 的节段在所有节段中具有最低的区域 11C-HED RI（事后检验中 P < 0.001）。多变量分析表明，收缩期壁增厚和 LGE 范围是 HFpEF 患者局部 11C-HED RI 的显着预测因子（均 P = 0.001）。结论 区域交感神经去神经与 HFpEF 患者的收缩功能障碍和纤维化负担相关，提示区域交感神经去神经可以提供 HFpEF 心肌损伤的综合测量。
Purpose This investigation aimed to identify significant predictors of regional sympathetic denervation quantified by (11)Chydroxyephedrine (HED) positron emission tomography (PET) in patients with heart failure with preserved left ventricular ejection fraction (HFpEF).Methods Included in the study were 34 patients (age 63 +/- 15 years, 23 men) with HFpEF (left ventricular ejection fraction >= 40%) and 11 age-matched volunteers without heartfailure. Cardiac magnetic resonance imaging was performed to measure left ventricular size and function, and the extent of myocardial late gadolinium enhancement (LGE). 11C-HED PETwas performed to quantify myocardial sympathetic innervation that was expressed as a 11C-HED retention index (RI, %/ min). To identify predictors of regional 11C-HED RI in HFpEF patients, we propose a multivariate mixed-effects model for repeated measures over segments with an unstructured covariance matrix.Results Global 11C-HED RI was significantly lower and more heterogeneous in HFpEF patients than in volunteers (P < 0.01 for all). Regional 11C-HED RI was correlated positively with systolic wall thickening (r = 0.42, P < 0.001) and negatively with the extent of LGE (r = -0.43, P < 0.001). Segments in HFpEF patients with a large extent of LGE had the lowest regional 11C-HED RI among all segments (P < 0.001 in post hoc tests). Multivariate analysis demonstrated that systolic wall thickening and the extent of LGE were significant predictors of regional 11C-HED RI in HFpEF patients (both P = 0.001).Conclusion Regional sympathetic denervation was associated with contractile dysfunction and fibrotic burden in HFpEF patients, suggesting that regional sympathetic denervation may provide an integrated measure ofmyocardial damage in HFpEF.