TY - JOUR
T1 - Transcatheter aortic valve implantation improves cardiac sympathetic nerve activity on 123 I-metaiodobenzylguanidine myocardial scintigraphy in severe aortic valve stenosis
AU - Sobajima, Mitsuo
AU - Ueno, Hiroshi
AU - Onoda, Hiroshi
AU - Kuwahara, Hiroyuki
AU - Tanaka, Shuhei
AU - Ushijima, Ryuichi
AU - Fukuda, Nobuyuki
AU - Yokoyama, Shigeki
AU - Nagura, Saori
AU - Doi, Toshio
AU - Yamashita, Akio
AU - Fukahara, Kazuaki
AU - Ito, Hisakatsu
AU - Kinugawa, Koichiro
N1 - Publisher Copyright:
© 2018, Japanese Circulation Society. All rights reserved.
PY - 2018
Y1 - 2018
N2 - Background: There is a consensus that overactivation of the cardiac sympathetic nervous system (CSN) proportionately increases the severity of heart failure and is accompanied by worse prognosis. Because it is unknown whether patients with aortic valve stenosis (AS) have similar CSN activation, we investigated the effect of transcatheter aortic valve implantation (TAVI). Methods and Results: We enrolled 31 consecutive patients with AS treated by TAVI. 123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy was performed at baseline and at 2 weeks after TAVI. At baseline, the early heart-mediastinum ratio (H/M) was within normal limits (3.0±0.5), but the delayed H/M was low (2.6±0.6) and the washout rate (WR) was high (34±13%). WR negatively correlated with aortic valve area (r=−0.389, P<0.01) and cardiac output (r=−0.595, P<0.01) and positively correlated with norepinephrine (r=0.519, P<0.01) and log NT-proBNP level (r=0.613, P<0.01). After TAVI, there were significant decreases in the norepinephrine level (366±179 ng/mL vs. 276±125 ng/mL, P<0.01) and WR (34±13 vs. 26±11%, P<0.01). Conclusions: The WR of MIBG was a useful marker of CSN activity and severity of AS. Immediate improvement of CSN activity after TAVI implied that AS hemodynamics per se enhanced CSN.
AB - Background: There is a consensus that overactivation of the cardiac sympathetic nervous system (CSN) proportionately increases the severity of heart failure and is accompanied by worse prognosis. Because it is unknown whether patients with aortic valve stenosis (AS) have similar CSN activation, we investigated the effect of transcatheter aortic valve implantation (TAVI). Methods and Results: We enrolled 31 consecutive patients with AS treated by TAVI. 123 I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy was performed at baseline and at 2 weeks after TAVI. At baseline, the early heart-mediastinum ratio (H/M) was within normal limits (3.0±0.5), but the delayed H/M was low (2.6±0.6) and the washout rate (WR) was high (34±13%). WR negatively correlated with aortic valve area (r=−0.389, P<0.01) and cardiac output (r=−0.595, P<0.01) and positively correlated with norepinephrine (r=0.519, P<0.01) and log NT-proBNP level (r=0.613, P<0.01). After TAVI, there were significant decreases in the norepinephrine level (366±179 ng/mL vs. 276±125 ng/mL, P<0.01) and WR (34±13 vs. 26±11%, P<0.01). Conclusions: The WR of MIBG was a useful marker of CSN activity and severity of AS. Immediate improvement of CSN activity after TAVI implied that AS hemodynamics per se enhanced CSN.
KW - Aortic valve stenosis
KW - Cardiac sympathetic nerve activity
KW - I-metaiodobenzylguanidine (MIBG)
KW - Transcatheter aortic valve implantation (TAVI)
UR - http://www.scopus.com/inward/record.url?scp=85041039185&partnerID=8YFLogxK
U2 - 10.1253/circj.CJ-17-0817
DO - 10.1253/circj.CJ-17-0817
M3 - 学術論文
C2 - 28966286
AN - SCOPUS:85041039185
SN - 1346-9843
VL - 82
SP - 579
EP - 585
JO - Circulation Journal
JF - Circulation Journal
IS - 2
ER -