Heterogeneous response of cardiac sympathetic function to cardiac resynchronization therapy in heart failure documented by 11[C]-hydroxy-ephedrine and PET/CT
Heterogeneous response of cardiac sympathetic function to cardiac resynchronization therapy in heart failure documented by 11[C]-hydroxy-ephedrine and PET/CT
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DOI：
10.1016/j.nucmedbio.2015.07.002
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发表时间：
2015-11-01
影响因子：
3.1
通讯作者：
Sambuceti, Gianmario
中科院分区：
文献类型：
--
作者：
Capitanio, Selene;Nanni, Cristina;Sambuceti, Gianmario
引言：心脏起搏治疗（CRT）是终末期心力衰竭患者的公认治疗方法。PET允许绝对量化心脏交感神经支配的整体和区域均匀性。我们评估了特发性心力衰竭（IHF）患者心脏肾上腺素能活动的变化（NYHA III-IV）CRT后使用C-11-羟麻黄碱（HED）PET/CT。（平均年龄= 68岁;范围= 55-81岁;平均左心室射血分数26 +/- 4%）接受了3项HED PET/CT研究：非活动器械植入后1周进行PET 1; PET 2，在刺激节律下进行PET 1后1周; PET 3，在活动CRT下进行3个月。采用专用软件（PMOD 3.4版本）通过17段极坐标图估计HED的整体和局部心脏摄取。结果：基线时，HED摄取在整个左心室呈不均匀分布，变异系数为18 ± 5%。CRT治疗3个月后，该变量显著降低（12 ± 5%，p < 0.01）。有趣的是，细分170个心肌节段（每例患者的17个节段乘以患者数量）分为两组，根据示踪剂摄取的中值表示为最大心肌摄取的%（76%），我们观察到取决于基线神经支配的不同行为：HED摄取仅在“神经支配受损”的节段中显著增加（PET 1时SUV为2.61 +/- 0.92，3个月时SUV为3.05 +/- 1.67，p
Introduction: Cardiac resynchronization therapy (CRT) is an accepted treatment in patients with end-stage heart failure. PET permits the absolute quantification of global and regional homogeneity in cardiac sympathetic innervation. We evaluated the variation of cardiac adrenergic activity in patients with idiopathic heart failure (IHF) disease (NYHA III-IV) after CRT using C-11-hydroxyephedrine (HED) PET/CT.Methods: Ten IHF patients (mean age = 68; range = 55-81; average left ventricular ejection fraction 26 +/- 4%) implanted with a resynchronization device underwent three HED PET/CT studies: PET 1 one week after inactive device implantation; PET 2, one week after PET 1 under stimulated rhythm; PET 3, at 3 months under active CRT. A dedicated software (PMOD 3.4 version) was used to estimate global and regional cardiac uptake of HED through 17 segment polar maps.Results: At baseline, HED uptake was heterogeneously distributed throughout the left ventricle with a variation coefficient of 18 +/- 5%. This variable markedly decreased after three months CRT (12 +/- 5%, p < 0.01). Interestingly, subdividing the 170 myocardial segments (17 segments of each patient multiplied by the number of patients) into two groups, according to the median value of tracer uptake expressed as % of maximal myocardial uptake (76%), we observed a different behaviour depending on baseline innervation: HED uptake significantly increased only in segments with "impaired innervation" (SUV 2.61 +/- 0.92 at PET1 and 3.05 +/- 1.67 at three months, p