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Significant correlation between renal 123I-metaiodobenzylguanidine scintigraphy and muscle sympathetic nerve activity in patients with primary hypertension

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy is used as a noninvasive imaging method for assessing cardiac sympathetic nerve activity. We tested the hypothesis that renal 123I-MIBG imaging is correlated with muscle sympathetic nerve activity (MSNA) in patients with primary hypertension.

Methods

Thirty-one consecutive patients with primary hypertension were included. Multiunit MSNA was recorded from the peroneal nerve to evaluate direct efferent sympathetic nerve activity. Planar renal and cardiac 123I-MIBG images were acquired. Early and delayed kidney-to-mediastinum ratio (K/M), early and delayed heart-to-mediastinum ratio (H/M), and washout rates (WR) were calculated.

Results

In 27 of 31 patients, blood pressure was controlled on antihypertensive medication. Mean systolic and diastolic blood pressures were 118 ± 18 and 67 ± 15 mmHg, respectively. Although early and late K/M and H/M were not significantly correlated with MSNA, both cardiac and average renal WR were significantly correlated with MSNA (r = 0.45, P = .0035 and r = 0.68, P < .001, respectively). Right and left renal WR were similarly correlated with MSNA. Renal WR was significantly higher than cardiac WR (43.2% vs 25.8%, P < .001) in these patients with hypertension.

Conclusions

Renal 123I-MIBG WR was significantly associated with multiunit MSNA. Renal 123I-MIBG imaging offers a noninvasive clinical methodology for assessing renal sympathetic nerve function.

Resumen

Antecedentes

la centellografía con 123I-metayodobencilguanidina (123I-MIBG) es utilizada como una método de imagen no invasivo para la evaluación de la actividad nerviosa simpática cardiaca. Evaluamos la hipótesis de si la imagen renal con 123I-MIBG esta relacionada con la actividad nerviosa simpática muscular (ANSM) en pacientes con hipertensión primaria.

Métodos

Treinta y cinco pacientes consecutivos con hipertensión primaria fueron incluidos. La ANSM fue registrada a partir del nervio peroneo para evaluar directamente la actividad nerviosa simpática eferente. Se adquirieron imágenes planares renales y cardiacas con 123I-MIBG. Se calcularon las relaciones tempranas y tardías de riñón/mediastino (R/M), corazón/mediastino (C/M) así como las tasas de lavado.

Resultados

En 27 de 31 pacientes, la presión arterial estaba controlada con terapia antihipertensiva. La presión promedio sistólica y diastólica fue de 118 ± 18 y 67 ± 15 mmHg, respectivamente. Aunque las relaciones R/M y C/M tempranas y tardías no se relacionaron significativamente con la ANSM, las tasas de lavado tanto cardiaca como renal promedio si se correlacionaron de forma significativa con la ANSM (r = 0.45, P = .0035 y r = 0.68, P < .001, respectivamente). Las tasas de lavado renal derecha e izquierda estuvieron relacionadas de forma similar con la ANSM. La tasa de lavado renal fue significativamente mayor que la tasa de lavado cardiaca (43.2% vs 25.8%, P < .001) en estos pacientes hipertensos.

Conclusiones

La tasa de lavado renal de 123I-MIBG estuvo significativamente asociada con la ANSM. La imagen renal con 123I-MIBG ofrece un método clínico no invasivo para la evaluación de la función nerviosa simpática renal.

摘要

背景

碘-123 间碘苯甲胍 (123I-MIBG) 闪烁显像作为一种非侵入式的显像方法被用来评估心脏交感神经活动。本研究旨在证实肾脏 123I-MIBG 显像在原发性高血压患者中与肌肉交感神经活性 (MSNA) 相关联。

方法

入选 31 例原发性高血压患者。记录腓神经的复合MSNA来评价传出神经的直接交感神经活性。同时采集肾脏和心脏的二维123I-MIBG图像,分别计算出早期与延迟的肾脏/纵隔比率 (K/M)、心脏/纵隔比率 (H/M)以及洗脱率 (WR) 。

结果

31 例病人中,有27例服用降压药,平均收缩压和舒张压分别是 118 ± 18 和67 ± 15 mmHg。早期与延迟的K/M和H/M均不与MSNA相关,但是心脏和肾脏的WR都与MSNA明显相关(r = 0.45, P = .0035; r = 0.68, P < .001) 。左右肾脏的 WR 与 MSNA 之间的相关性无差别,肾脏的WR要明显高于心脏的WR (43.2% vs 25.8%, P < .001) 。

结论

肾脏 123I-MIBG 的洗脱率与肌肉交感神经活性明显相关。肾脏的123I-MIBG显像能够用于无创评估肾脏交感神经功能 。

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Abbreviations

MIBG:

Metaiodobenzylguanidine

MSNA:

Muscle sympathetic nerve activity

K/M:

Kidney-to-mediastinum ratio

H/M:

Heart-to-mediastinum ratio

WR:

Washout rate

RDN:

Renal denervation

ROI:

Region of interest

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Acknowledgements

This work was supported by JSPS KAKENHI Grant-in-Aid for Scientific Research (C) Number 26350497. We gratefully acknowledge the suggestions by John S Floras, MD, DPhil. Also, this article was finalized under the auspices of the “Mentorship at Distance” committee of the Journal of Nuclear Cardiology. We gratefully acknowledge the editorial suggestions by Frans J. Th. Wackers, MD, PhD.

Disclosures

The authors declare that there are no conflicts of interest, financial or otherwise, related to this study.

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Correspondence to Hisayoshi Murai.

Additional information

Masayuki Takamura and Yoshitaka Okabe contributed equally to this work.

JNC thanks Erick Alexanderson MD, Carlos Guitar MD, and Diego Vences MD, UNAM, Mexico, for providing the Spanish abstract, and Haipeng Tang MS, Zhixin Jiang MD, and Weihua Zhou PhD, for providing the Chinese abstract.

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Takamura, M., Murai, H., Okabe, Y. et al. Significant correlation between renal 123I-metaiodobenzylguanidine scintigraphy and muscle sympathetic nerve activity in patients with primary hypertension. J. Nucl. Cardiol. 24, 363–371 (2017). https://doi.org/10.1007/s12350-016-0760-4

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  • DOI: https://doi.org/10.1007/s12350-016-0760-4

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