Skip to main content
SpringerLink
Log in

Relationships between left ventricular sympathetic innervation and diastolic dysfunction: the role of myocardial innervation/perfusion mismatch

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

A possible relationship between cardiac sympathetic denervation and left ventricular (LV) diastolic dysfunction has been suggested. However, an evaluation of the interactions between myocardial adrenergic tone and LV perfusion and diastolic function is lacking.

Methods and results

Seventy-two patients underwent 99mTc-tetrofosmin/123I-metaiodobenzylguanidine (123I-MIBG) cardiac Cadmium-Zinc-Telluride (CZT) imaging. The summed rest score (SRS) and summed 123I-MIBG score (SS-MIBG) were computed as measures of regional perfusion and innervation heterogeneities. LV segments showing an impaired innervation, despite a relatively preserved perfusion (99mTc-tetrofosmin-123I-MIBG tracers’ uptake ≥25%), were individuated (innervation/perfusion mismatch). The peak filling rate (PFR) was computed as a measure of LV diastolic function. Nineteen of the 72 (26%) patients presented a normal LV diastolic function, while 29 (40%) and 24 (34%) had a mild and overt diastolic dysfunction. Subjects with diastolic dysfunction showed more abnormal SRS and SS-MIBG values (P < 0.001). In the global population, 502/1224 (41%) LV segments showed an innervation/perfusion mismatch. A modest correlation between the extent of cardiac innervation/perfusion mismatch and PFR values was evident (R = −0.27, P = 0.029). On multivariate analysis, the extent of regional innervation/perfusion mismatch remained an independent predictor of overt LV diastolic abnormalities (P = 0.017).

Conclusions

The burden of LV regions showing an innervation/perfusion mismatch associates with the occurrence of overt diastolic dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

Abbreviations

CZT:

Cadmium-Zinc-Telluride

SPECT:

Single-photon emission computed tomography

PFR:

Peak filling rate

123I-MIBG:

123I-metaiodobenzylguanidine

SRS:

Summed rest score

SS-MIBG:

Summed 123I-MIBG score

References

  1. Carrió I, Cowie MR, Yamazaki J, Udelson J, Camici PG. Cardiac sympathetic imaging with MIBG in heart failure. JACC Cardiovasc Imaging 2010;3:92-100.

    Article  PubMed  Google Scholar 

  2. Jacobson AF, Senior R, Cerqueira MD, Wong ND, Thomas GS, Lopez VA, et al. Myocardial iodine-123 meta-iodobenzylguanidine imaging and cardiac events in heart failure. Results of the prospective ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) study. J Am Coll Cardiol 2010;55:2212-21.

    Article  PubMed  Google Scholar 

  3. Dimitriu-Leen AC, Gimelli A, Al Younis I, Veltman CE, Verberne HJ, Wolterbeek R, et al. The impact of acquisition time of planar cardiac (123)I-MIBG imaging on the late heart to mediastinum ratio. Eur J Nucl Med Mol Imaging 2016;43:326-32.

    Article  PubMed  Google Scholar 

  4. Clements IP, Garcia EV, Chen J, Folks RD, Butler J, Jacobson AF. Quantitative iodine-123-metaiodobenzylguanidine (MIBG) SPECT imaging in heart failure with left ventricular systolic dysfunction: Development and validation of automated procedures in conjunction with technetium-99m tetrofosmin myocardial perfusion SPECT. J Nucl Cardiol 2016;23:425-35.

    Article  PubMed  Google Scholar 

  5. Gimelli A, Liga R, Giorgetti A, Genovesi D, Marzullo P. Assessment of myocardial adrenergic innervation with a solid-state dedicated cardiac cadmium-zinc-telluride camera: first clinical experience. Eur Heart J Cardiovasc Imaging 2014;15:575-85.

    Article  PubMed  Google Scholar 

  6. Gimelli A, Liga R, Genovesi D, Giorgetti A, Kusch A, Marzullo P. Association between left ventricular regional sympathetic denervation and mechanical dyssynchrony in phase analysis: a cardiac CZT study. Eur J Nucl Med Mol Imaging 2014;41:946-55.

    Article  PubMed  Google Scholar 

  7. Bax JJ, Kraft O, Buxton AE, Fjeld JG, Parízek P, Agostini D, et al. 123I-mIBG scintigraphy to predict inducibility of ventricular arrhythmias on cardiac electrophysiology testing. Circ Cardiovasc Imaging 2008;1:131-40.

    Article  PubMed  Google Scholar 

  8. Gimelli A, Masci PG, Liga R, Grigoratos C, Pasanisi EM, Lombardi M, et al. Regional heterogeneity in cardiac sympathetic innervation in acute myocardial infarction: relationship with myocardial oedema on magnetic resonance. Eur J Nucl Med Mol Imaging 2014;41:1692-4.

    Article  PubMed  Google Scholar 

  9. Sasano T, Abraham MR, Chang KC, Ashikaga H, Mills KJ, Holt DP, et al. Abnormal sympathetic innervation of viable myocardium and the substrate of ventricular tachycardia after myocardial infarction. J Am Coll Cardiol 2008;51:2266-75.

    Article  PubMed  Google Scholar 

  10. Spinelli L, Pellegrino T, Pisani A, Giudice CA, Riccio E, Imbriaco M, et al. Relationship between left ventricular diastolic function and myocardial sympathetic denervation measured by (123)I-meta-iodobenzylguanidine imaging in Anderson-Fabry disease. Eur J Nucl Med Mol Imaging 2016;43:729-39.

    Article  PubMed  CAS  Google Scholar 

  11. Miranda DP, dos Santos MJ, Salemi VM, de Oliveira EP, Verberne HJ, da Rocha ET. Differential effects of variation in athletes training on myocardial morphophysiological adaptation in men: focus on 123I-MIBG assessed myocardial sympathetic activity. J Nucl Cardiol 2014;21:570-7.

    PubMed  Google Scholar 

  12. Gimelli A, Liga R, Pasanisi EM, Giorgetti A, Marras G, Favilli B, et al. Evaluation of left ventricular diastolic function with a dedicated cadmium-zinc-telluride cardiac camera: comparison with Doppler echocardiography. Eur Heart J Cardiovasc Imaging 2014;15:972-9.

    Article  PubMed  Google Scholar 

  13. Gimelli A, Liga R, Bottai M, Pasanisi EM, Giorgetti A, Fucci S, et al. Diastolic dysfunction assessed by ultra-fast cadmium-zinc-telluride cardiac imaging: impact on the evaluation of ischaemia. Eur Heart J Cardiovasc Imaging 2015;16:68-73.

    Article  PubMed  Google Scholar 

  14. Kapur A, Latus KA, Davies G, Dhawan RT, Eastick S, Jarritt PH, et al. A comparison of three radionuclide myocardial perfusion tracers in clinical practice: the ROBUST study. Eur J Nucl Med Mol Imaging 2002;29:1608-16.

    Article  PubMed  CAS  Google Scholar 

  15. Gimelli A, Liga R, Giorgetti A, Kusch A, Pasanisi EM, Marzullo P. Relationships between myocardial perfusion abnormalities and poststress left ventricular functional impairment on cadmium-zinc-telluride imaging. Eur J Nucl Med Mol Imaging 2015;42:994-1003.

    Article  PubMed  CAS  Google Scholar 

  16. Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med 2014;370:1383-92.

    Article  PubMed  CAS  Google Scholar 

  17. Gimelli A, Liga R, Pasanisi EM, Casagranda M, Marzullo P. Myocardial ischemia in the absence of obstructive coronary lesion: The role of post-stress diastolic dysfunction in detecting early coronary atherosclerosis. J Nucl Cardiol 2016.

  18. Somsen GA, Dubois EA, Brandsma K, de Jong J, van der Wouw PA, Batink HD, et al. Cardiac sympathetic neuronal function in left ventricular volume and pressure overload. Cardiovasc Res 1996;31:132-8.

    Article  PubMed  CAS  Google Scholar 

  19. Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003;289:194-202.

    Article  PubMed  Google Scholar 

  20. Grassi G, Seravalle G, Quarti-Trevano F, Dell’Oro R, Arenare F, Spaziani D, et al. Sympathetic and baroreflex cardiovascular control in hypertension-related left ventricular dysfunction. Hypertension 2009;53:205-9.

    Article  PubMed  CAS  Google Scholar 

  21. Gaemperli O, Liga R, Bhamra-Ariza P, Rimoldi O. Nicotine addiction and coronary artery disease: impact of cessation interventions. Curr Pharm Des 2010;16:2586-97.

    Article  PubMed  CAS  Google Scholar 

  22. Blaire T, Bailliez A, Bouallegue FB, Bellevre D, Agostini D, Manrique A. Left ventricular function assessment using 123I/99mTc dual-isotope acquisition with two semi-conductor cadmium-zinc-telluride (CZT) cameras: a gated cardiac phantom study. EJNMMI Phys 2016;3:27.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bellevre D, Manrique A, Legallois D, Bross S, Baavour R, Roth N, et al. First determination of the heart-to-mediastinum ratio using cardiac dual isotope (123I-MIBG/99mTc-tetrofosmin) CZT imaging in patients with heart failure: the ADRECARD study. Eur J Nucl Med Mol Imaging 2015;42:1912-9.

    Article  PubMed  Google Scholar 

  24. Schulman DS, Herman BA, Ziady G, Edwards T, Kormos R, Reddy PS, et al. Effects of acute alterations in left ventricular loading conditions on peak filling rate in the denervated (transplanted) ventricle. Am J Cardiol 1991;67:1103-9.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

Alessia Gimelli, Riccardo Liga, Francesco Avogliero, Michele Cocecani, and Paolo Marzullo have no conflicts of interest.

Author information

Authors and Affiliations

  1. Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy

    Alessia Gimelli MD, Francesco Avogliero MD, Michele Coceani MD & Paolo Marzullo MD

  2. Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy

    Riccardo Liga MD

  3. CNR, Institute of Clinical Physiology, Pisa, Italy

    Paolo Marzullo MD

Authors
  1. Alessia Gimelli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riccardo Liga MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Avogliero MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michele Coceani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paolo Marzullo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessia Gimelli MD.

Additional information

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

Alessia Gimelli and Riccardo Liga shared first co-authorship.

Electronic supplementary material

Below is the link to the electronic supplementary material.

12350_2016_753_MOESM1_ESM.jpg

Supplementary material 1 (JPEG 63 kb)Suppl. Fig. 1 Relationships between LV PFR and the burden of innervation/perfusion mismatch in patients with preserved EF (A) and in those without IHD (B).

12350_2016_753_MOESM2_ESM.jpg

Supplementary material 2 (JPEG 118 kb)Suppl. Fig. 2 Relationships between LV systolic function (EF) and (A) diastolic function (PFR), (B) regional myocardial perfusion (summed rest score) and (C) innervation (SS-MIBG), and (D) the burden of innervation/perfusion mismatch

Supplementary material 3 (PPT 440 kb)

Supplementary material 4 (DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gimelli, A., Liga, R., Avogliero, F. et al. Relationships between left ventricular sympathetic innervation and diastolic dysfunction: the role of myocardial innervation/perfusion mismatch. J. Nucl. Cardiol. 25, 1101–1109 (2018). https://doi.org/10.1007/s12350-016-0753-3

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-016-0753-3

Keywords

Search

Navigation