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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-05-2014 | Original Article

Association between left ventricular regional sympathetic denervation and mechanical dyssynchrony in phase analysis: a cardiac CZT study

Authors: Alessia Gimelli, Riccardo Liga, Dario Genovesi, Assuero Giorgetti, Annette Kusch, Paolo Marzullo

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 5/2014

Abstract

Purpose

To evaluate the relationships among myocardial sympathetic innervation, perfusion and mechanical synchronicity assessed with cardiac cadmium-zinc-telluride (CZT) scintigraphy.

Methods

A group of 29 patients underwent an evaluation of myocardial perfusion with ^99mTc-tetrofosmin CZT scintigraphy and adrenergic innervation with ¹²³I-metaiodobenzylguanidine (MIBG) CZT scintigraphy. The summed rest score (SRS), motion score (SMS) and thickening score (STS), as well as the summed ¹²³I-MIBG defect score (SS-MIBG), were determined. Regional tracer uptake for both ^99mTc-tetrofosmin and ¹²³I-MIBG was also calculated. Finally, the presence of significant myocardial mechanical dyssynchrony was evaluated in phase analysis on gated CZT images and the region of latest mechanical activation identified.

Results

Significant mechanical dyssynchrony was present in 17 patients (59 %) and associated with higher SRS (P = 0.030), SMS (P < 0.001), STS (P = 0.003) and early SS-MIBG (P = 0.037) as well as greater impairments in left ventricular ejection fraction (P < 0.001) and end-diastolic volume (P < 0.001). In multivariate analysis a higher end-diastolic volume remained the only predictor of mechanical dyssynchrony (P = 0.047). Interestingly, while in the whole population regional myocardial perfusion and adrenergic activity were strongly correlated (R = 0.68), in patients with mechanical dyssynchrony the region of latest mechanical activation was predicted only by greater impairment in regional ¹²³I-MIBG uptake (P = 0.012) that overwhelmed the effect of depressed regional perfusion.

Conclusion

Left ventricular mechanical dyssynchrony is associated with greater depression in contractile function and greater impairments in regional myocardial perfusion and sympathetic activity. In patients with dyssynchrony, the region of latest mechanical activation is characterized by a significantly altered adrenergic tone.

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Title: Association between left ventricular regional sympathetic denervation and mechanical dyssynchrony in phase analysis: a cardiac CZT study
Authors: Alessia Gimelli
Riccardo Liga
Dario Genovesi
Assuero Giorgetti
Annette Kusch
Paolo Marzullo
Publication date: 01-05-2014
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 5/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-013-2640-3

At a glance: The STEP trials

Springer Medicine

Association between left ventricular regional sympathetic denervation and mechanical dyssynchrony in phase analysis: a cardiac CZT study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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