Heterogeneity of Ventricular Sympathetic Nervous Activity is Associated with Clinically Relevant Ventricular Arrhythmia in Postoperative Patients with Tetralogy of Fallot
Heterogeneity of Ventricular Sympathetic Nervous Activity is Associated with Clinically Relevant Ventricular Arrhythmia in Postoperative Patients with Tetralogy of Fallot
复制标题
法洛四联症术后患者心室交感神经活动的异质性与临床相关室性心律失常相关
DOI：
10.1007/s00246-015-1195-4
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发表时间：
2015
影响因子：
1.6
通讯作者：
O. Yamada
中科院分区：
文献类型：
--
作者：
S. Ono;H. Ohuchi;A. Miyazaki;Tadaaki Abe;K. Kiso;O. Yamada
本研究旨在探讨法洛四联症患者术后室交感神经活动是否与临床相关的室性心律失常(≥连续3次室性心动过速)有关。我们在日本的国家儿科心脏病学转诊中心进行了一项回顾性研究。术后TOF患者24例(男性13例，中位年龄17岁)，均行心肌~(123)I间苯基胍(MIBG)心肌显像。我们通过平面MIBG心肌显像测量心脏与纵隔的比率(HMR)和洗脱率(WR)。层析图像和地形图由20个节段组成。计算心肌20个节段摄取百分率的标准差(SD-摄取)，作为心肌异质性摄取MIBG的指标。我们将这些来自MIBG的变量与患者的临床特征进行了比较，包括心电图和血流动力学。24例患者中8例有RVA(RVA组)，16例无RVA(非RVA组)。HMR(1.9±0.50比2.2±10.4)和WR(50比42±0.10)两组间差异无统计学意义。RVA组的SD摄取率显著高于非RVA组(15±0.3比12±0.3，P=0.03)。RVA组QT间期离散度(Ms)也高于非RVA组(53±0.23比44±0.18，P=0.04)。多因素Logistic回归分析显示，SD摄取和QT离散度是RVA组的独立预测因素(p=0.02，p=0.03)。除了较大的QT离散度，不同的SNA与TOF患者术后的RVA相关。
This study aimed to clarify whether there is an association between ventricular sympathetic nervous activity (SNA) and clinically relevant ventricular arrhythmia (a run of ≥3 consecutive ventricular beats, RVA) in postoperative patients with tetralogy of Fallot (TOF). We performed a retrospective study in a national referral center of pediatric cardiology in Japan. Twenty-four postoperative TOF patients (13 males, median age 17 years) undergoing myocardial 123I metaiodobenzylguanidine (MIBG) scintigraphy were included. We measured the heart-to-mediastinum ratio (HMR) and washout ratio (WR) from planar MIBG myocardial scintigraphy. Tomographic images and polar maps were generated with 20 segments. The standard deviation of percentage uptake of 20 segments (SD-uptake) as an index of heterogeneous MIBG uptake to the ventricular myocardium was calculated. We compared these MIBG-derived variables with the patients’ clinical profiles, including ECG findings and hemodynamics. Eight of 24 patients had RVA (RVA group), and the other 16 did not have RVA (non-RVA group). There were no significant differences in the HMR (1.9 ± 0.5 vs. 2.2 ± 0.4) and WR (50 ± 5 vs. 42 ± 10) between the two groups. SD-uptake was significantly higher in the RVA group than in the non-RVA group (15 ± 3 vs. 12 ± 3, p = 0.03). QT dispersion (ms) was also higher in the RVA group than in the non-RVA group (53 ± 23 vs. 44 ± 18, p = 0.04). Multivariate logistic regression showed that SD-uptake and QT dispersion were independent predictors in the RVA group (p = 0.02, p = 0.03). In addition to greater QT dispersion, heterogeneous SNA is associated with RVA in TOF patients postoperatively.