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Interactions between myocardial sympathetic denervation and left ventricular mechanical dyssynchrony: A CZT analysis

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

Abstract

Background

A correlation between left ventricular (LV) dyssynchrony (LVD) and impaired myocardial sympathetic tone has been hypothesized. We sought to assess the interactions between regional LV sympathetic innervation, perfusion, and mechanical dyssynchrony.

Methods

Eighty-three patients underwent evaluation of LV perfusion and sympathetic innervation on 99mTc-tetrofosmin/123I-metaiodobenzylguanidine (123I-MIBG) imaging. The summed rest score and summed 123I-MIBG score (SS-MIBG) were computed. The extent of “innervation/perfusion” mismatch was defined as the number of denervated LV segments with relatively preserved perfusion. LVD was evaluated on phase analysis and the wall with latest mechanical activation identified.

Results

LVD was revealed in 36 (43%) patients. Patients with LVD had more abnormal values of SRS (21 ± 9 vs 10 ± 8, P < 0.001) and SS-MIBG (29 ± 9 vs 17 ± 11, P < 0.001) than those without LVD. The presence of LVD also clustered with a higher burden of “innervation/perfusion” mismatch (P = 0.019). On per-wall analysis, LV walls with delayed mechanical activation showed a higher burden of “innervation/perfusion” mismatch (2.3 ± 1.4 segments) than normally contracting walls (1.3 ± 1.2 segments; P < 0.001). On multivariate analysis, the extent of “innervation/perfusion” mismatch was the only predictor of delayed mechanical activation (P = 0.029).

Conclusions

Patients with LVD show an elevated burden of “innervation/perfusion” mismatch that is concentrated at the level of the most dyssynchronous walls.

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Abbreviations

SPECT:

Single-photon emission computed tomography

CZT:

Cadmium-zinc-telluride

LVD:

Left ventricular dyssynchrony

123I-MIBG:

123I-metaiodobenzylguanidine

SRS:

Summed rest score

SS-MIBG:

Summed 123I-MIBG score

SD:

Standard deviation

References

  1. Bax JJ, Bleeker GB, Marwick TH, Molhoek SG, Boersma E, Steendijk P, et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol 2004;44:1834-40.

    Article  PubMed  Google Scholar 

  2. Hess PL, Shaw LK, Fudim M, Iskandrian AE, Borges-Neto S. The prognostic value of mechanical left ventricular dyssynchrony defined by phase analysis from gated single-photon emission computed tomography myocardial perfusion imaging among patients with coronary heart disease. J Nucl Cardiol 2017;24:482-90.

    Article  PubMed  Google Scholar 

  3. AlJaroudi W, Aggarwal H, Venkataraman R, Heo J, Iskandrian AE, Hage FG. Impact of left ventricular dyssynchrony by phase analysis on cardiovascular outcomes in patients with end-stage renal disease. J Nucl Cardiol 2010;17:1058-64.

    Article  PubMed  Google Scholar 

  4. Leong DP, Chakrabarty A, Shipp N, Molaee P, Madsen PL, Joerg L, et al. Effects of myocardial fibrosis and ventricular dyssynchrony on response to therapy in new-presentation idiopathic dilated cardiomyopathy: Insights from cardiovascular magnetic resonance and echocardiography. Eur Heart J 2012;33:640-8.

    Article  CAS  PubMed  Google Scholar 

  5. Morris DA, Vaz Pérez A, Blaschke F, Eichstädt H, Ozcelik C, Haverkamp W. Myocardial systolic and diastolic consequences of left ventricular mechanical dyssynchrony in heart failure with normal left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2012;13:556-67.

    Article  PubMed  Google Scholar 

  6. Dauphin R, Nonin E, Bontemps L, Vincent M, Pinel A, Bonijoly S, et al. Quantification of ventricular resynchronization reserve by radionuclide phase analysis in heart failure patients: A prospective long-term study. Circ Cardiovasc Imaging 2011;4:114-21.

    Article  PubMed  Google Scholar 

  7. Nakajima K, Okuda K, Matsuo S, Kiso K, Kinuya S, Garcia EV. Comparison of phase dyssynchrony analysis using gated myocardial perfusion imaging with four software programs: Based on the Japanese Society of Nuclear Medicine working group normal database. J Nucl Cardiol 2017;24:611-21.

    Article  PubMed  Google Scholar 

  8. Gimelli A, Liga R, Duce V, Kusch A, Clemente A, Marzullo P. Accuracy of myocardial perfusion imaging in detecting multivessel coronary artery disease: A cardiac CZT study. J Nucl Cardiol 2016. doi:10.1007/s12350-015-0360-8.

    Article  PubMed  Google Scholar 

  9. Gimelli A, Bottai M, Giorgetti A, Genovesi D, Kusch A, Ripoli A, et al. Comparison between ultrafast and standard single-photon emission CT in patients with coronary artery disease: A pilot study. Circ Cardiovasc Imaging 2011;4:51-8.

    Article  PubMed  Google Scholar 

  10. Pazhenkottil AP, Buechel RR, Herzog BA, Nkoulou RN, Valenta I, Fehlmann U, et al. Ultrafast assessment of left ventricular dyssynchrony from nuclear myocardial perfusion imaging on a new high-speed gamma camera. Eur J Nucl Med Mol Imaging 2010;37:2086-92.

    Article  PubMed  Google Scholar 

  11. Gimelli A, Liga R, Giorgetti A, Favilli B, Pasanisi EM, Marzullo P. Determinants of left ventricular mechanical dyssynchrony in patients submitted to myocardial perfusion imaging: A cardiac CZT study. J Nucl Cardiol 2016;23:728-36.

    Article  PubMed  Google Scholar 

  12. 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 

  13. Tanaka H, Tatsumi K, Fujiwara S, Tsuji T, Kaneko A, Ryo K, et al. Effect of left ventricular dyssynchrony on cardiac sympathetic activity in heart failure patients with wide QRS duration. Circ J 2012;76:382-9.

    Article  PubMed  Google Scholar 

  14. 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 

  15. 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 

  16. 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 

  17. Fallavollita JA, Heavey BM, Luisi AJ Jr, Michalek SM, Baldwa S, Mashtare TL Jr, et al. Regional myocardial sympathetic denervation predicts the risk of sudden cardiac arrest in ischemic cardiomyopathy. J Am Coll Cardiol 2014;63:141-9.

    Article  PubMed  Google Scholar 

  18. 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  CAS  PubMed  Google Scholar 

  19. Genovesi D, Giorgetti A, Gimelli A, Kusch A, D’Aragona Tagliavia I, Casagranda M, et al. Impact of attenuation correction and gated acquisition in SPECT myocardial perfusion imaging: Results of the multicentre SPAG (SPECT Attenuation Correction vs Gated) study. Eur J Nucl Med Mol Imaging 2011;38:1890-8.

    Article  CAS  PubMed  Google Scholar 

  20. Gimelli A, Liga R, Avogliero F, Coceani M, Marzullo P. Relationships between left ventricular sympathetic innervation and diastolic dysfunction: The role of myocardial innervation/perfusion mismatch. J Nucl Cardiol 2016. doi:10.1007/s12350-016-0753-3.

    Article  PubMed  Google Scholar 

  21. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539-42.

    Article  PubMed  Google Scholar 

  22. 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 

  23. 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  CAS  PubMed  Google Scholar 

  24. Gorcsan J 3rd, Sogaard P, Bax JJ, Singh JP, Abraham WT, Borer JS, et al. Association of persistent or worsened echocardiographic dyssynchrony with unfavourable clinical outcomes in heart failure patients with narrow QRS width: A subgroup analysis of the EchoCRT trial. Eur Heart J 2016;37:49-59.

    Article  PubMed  Google Scholar 

  25. Boogers MJ, Borleffs CJ, Henneman MM, van Bommel RJ, van Ramshorst J, Boersma E, et al. Cardiac sympathetic denervation assessed with 123-iodine metaiodobenzylguanidine imaging predicts ventricular arrhythmias in implantable cardioverter-defibrillator patients. J Am Coll Cardiol 2010;55:2769-77.

    Article  PubMed  Google Scholar 

  26. Cha YM, Chareonthaitawee P, Dong YX, Kemp BJ, Oh JK, Miyazaki C, et al. Cardiac sympathetic reserve and response to cardiac resynchronization therapy. Circ Heart Fail 2011;4:339-44.

    Article  PubMed  Google Scholar 

  27. Hage FG, Aggarwal H, Patel K, Chen J, Jacobson AF, Heo J, et al. The relationship of left ventricular mechanical dyssynchrony and cardiac sympathetic denervation to potential sudden cardiac death events in systolic heart failure. J Nucl Cardiol 2014;21:78-85.

    Article  PubMed  Google Scholar 

  28. Gimelli A, Menichetti F, Soldati E, Liga R, Vannozzi A, Marzullo P, et al. Relationships between cardiac innervation/perfusion imbalance and ventricular arrhythmias: Impact on invasive electrophysiological parameters and ablation procedures. Eur J Nucl Med Mol Imaging 2016;43:2383-91.

    Article  CAS  PubMed  Google Scholar 

  29. Aljaroudi WA, Hage FG, Hermann D, Doppalapudi H, Venkataraman R, Heo J, et al. Relation of left-ventricular dyssynchrony by phase analysis of gated SPECT images and cardiovascular events in patients with implantable cardiac defibrillators. J Nucl Cardiol 2010;17:398-404.

    Article  PubMed  Google Scholar 

  30. 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-99 m tetrofosmin myocardial perfusion SPECT. J Nucl Cardiol 2016;23:425-35.

    Article  PubMed  Google Scholar 

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Author notes

  1. Drs Gimelli and Liga have contributed equally to the study and share the first co-authorship.

Authors and Affiliations

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

    Alessia Gimelli MD & Paolo Marzullo MD

  2. University of Pisa, Pisa, Italy

    Riccardo Liga MD

  3. Cardio-Thoracic and Vascular department, University Hospital of Pisa, Pisa, Italy

    Francesca Menichetti MD, Ezio Soldati MD & Maria Grazia Bongiorni MD

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

    Paolo Marzullo MD

Authors
  1. Alessia Gimelli MD
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  2. Riccardo Liga MD
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  3. Francesca Menichetti MD
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  4. Ezio Soldati MD
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  5. Maria Grazia Bongiorni MD
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  6. Paolo Marzullo MD
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Correspondence to Alessia Gimelli MD.

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Supplementary material 1 (PPT 436 kb)

12350_2017_1036_MOESM2_ESM.ppt

Supplementary material 2 (PPT 23 kb). Extent of “innervation/perfusion” mismatch (% of mismatched LV myocardium) on the different LV walls

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Gimelli, A., Liga, R., Menichetti, F. et al. Interactions between myocardial sympathetic denervation and left ventricular mechanical dyssynchrony: A CZT analysis. J. Nucl. Cardiol. 26, 509–518 (2019). https://doi.org/10.1007/s12350-017-1036-3

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  • DOI: https://doi.org/10.1007/s12350-017-1036-3

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