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Abstract：
BACKGROUND: 123Iodine-meta-iodobenzylguanidine scintigraphy is useful for assessing cardiac autonomic dysfunction and predict outcomes in heart failure (HF). The relationship of cardiac sympathetic function with myocardial remodeling and diffuse fibrosis remains largely unknown. We aimed to evaluate the cardiac sympathetic function of patients with HF and its relation with myocardial remodeling and exercise capacity.
RESULTS: Prospectively enrolled patients with HF (New York Heart Association class II-III) were stratified into HF with preserved left ventricular ejection fraction [LVEF] ≥45%) and reduced LVEF. Ventricular morphology/function and myocardial extracellular volume (ECV) fraction were quantified by cardiovascular magnetic resonance, global longitudinal strain by echocardiography, cardiac sympathetic function by heart-to-mediastinum ratio from 123iodine-meta-iodobenzylguanidine scintigraphy. All participants underwent cardiopulmonary exercise testing. The cohort included 33 patients with HF with preserved LVEF (LVEF, 60±10%; NT-proBNP [N-terminal pro-B-type natriuretic peptide], 248 [interquartile range, 79-574] pg/dL), 28 with HF with reduced LVEF (LVEF, 30±9%; NT-proBNP, 743 [interquartile range, 250-2054] pg/dL) and 20 controls (LVEF, 65±5%; NT-proBNP, 40 [interquartile range, 19-50] pg/dL). Delayed (4 hours) 123iodine-meta-iodobenzylguanidine heart-to-mediastinum ratio was lower in HF with preserved LVEF (1.59±0.25) and HF with reduced LVEF (1.45±0.16) versus controls (1.92±0.24; P<0.001), and correlated negatively with diffuse fibrosis assessed by ECV (R=-0.34, P<0.01). ECV in segments without LGE was increased in HF with preserved ejection fraction (0.32±0.05%) and HF with reduced left ventricular ejection fraction (0.31±0.04%) versus controls (0.28±0.04, P<0.05) and was associated with the age- and sex-adjusted maximum oxygen consumption (peak oxygen consumption); (R=-0.41, P<0.01). Preliminary analysis indicates that cardiac sympathetic function might potentially act as a mediator in the association between ECV and NT-proBNP levels.
CONCLUSIONS: Abnormally low cardiac sympathetic function in patients with HF with reduced and preserved LVEF is associated with extracellular volume expansion and decreased cardiopulmonary functional capacity.
RESULTS: Prospectively enrolled patients with HF (New York Heart Association class II-III) were stratified into HF with preserved left ventricular ejection fraction [LVEF] ≥45%) and reduced LVEF. Ventricular morphology/function and myocardial extracellular volume (ECV) fraction were quantified by cardiovascular magnetic resonance, global longitudinal strain by echocardiography, cardiac sympathetic function by heart-to-mediastinum ratio from 123iodine-meta-iodobenzylguanidine scintigraphy. All participants underwent cardiopulmonary exercise testing. The cohort included 33 patients with HF with preserved LVEF (LVEF, 60±10%; NT-proBNP [N-terminal pro-B-type natriuretic peptide], 248 [interquartile range, 79-574] pg/dL), 28 with HF with reduced LVEF (LVEF, 30±9%; NT-proBNP, 743 [interquartile range, 250-2054] pg/dL) and 20 controls (LVEF, 65±5%; NT-proBNP, 40 [interquartile range, 19-50] pg/dL). Delayed (4 hours) 123iodine-meta-iodobenzylguanidine heart-to-mediastinum ratio was lower in HF with preserved LVEF (1.59±0.25) and HF with reduced LVEF (1.45±0.16) versus controls (1.92±0.24; P<0.001), and correlated negatively with diffuse fibrosis assessed by ECV (R=-0.34, P<0.01). ECV in segments without LGE was increased in HF with preserved ejection fraction (0.32±0.05%) and HF with reduced left ventricular ejection fraction (0.31±0.04%) versus controls (0.28±0.04, P<0.05) and was associated with the age- and sex-adjusted maximum oxygen consumption (peak oxygen consumption); (R=-0.41, P<0.01). Preliminary analysis indicates that cardiac sympathetic function might potentially act as a mediator in the association between ECV and NT-proBNP levels.
CONCLUSIONS: Abnormally low cardiac sympathetic function in patients with HF with reduced and preserved LVEF is associated with extracellular volume expansion and decreased cardiopulmonary functional capacity.
摘要：
背景：123碘-间碘苄基胍闪烁显像可用于评估心脏自主神经功能障碍和预测心力衰竭（HF）的预后。心脏交感神经功能与心肌重塑和弥漫性纤维化的关系仍然未知。我们旨在评估HF患者的心脏交感神经功能及其与心肌重塑和运动能力的关系。
结果：前瞻性纳入的HF（纽约心脏协会II-III级）患者被分层为左心室射血分数[LVEF]保留≥45％的HF，LVEF降低。通过心血管磁共振量化心室形态/功能和心肌细胞外容积（ECV）分数，通过超声心动图的整体纵向应变，来自123碘-间碘苄基胍闪烁显像的心脏与纵隔比率的心脏交感神经功能。所有参与者都接受了心肺运动测试。该队列包括33例LVEF保留的HF患者（LVEF，60±10%；NT-proBNP[N末端B型利钠肽前体]，248[四分位数间距，79-574]pg/dL)，28具有降低的LVEF的HF（LVEF，30±9%;NT-proBNP,743[四分位间距,250-2054]pg/dL）和20个对照（LVEF，65±5%;NT-proBNP,40[四分位距，19-50]pg/dL)。延迟（4小时）123碘-间碘苄基胍心脏与纵隔的比率在LVEF保留的HF（1.59±0.25）和LVEF降低的HF（1.45±0.16）中低于对照组（1.92±0.24；P<0.001），与ECV评估的弥漫性纤维化呈负相关（R=-0.34，P<0.01）。与对照组（0.28±0.04，P<0.05）相比，无LGE节段的ECV在射血分数保留的HF（0.32±0.05％）和左心室射血分数降低的HF（0.31±0.04％）中增加，并且与年龄和性别调整的最大耗氧量（峰值耗氧量）；（R=-0.41，P<0.01）。初步分析表明，心脏交感神经功能可能是ECV和NT-proBNP水平之间关联的介质。
结论：LVEF降低和保留的HF患者心交感神经功能异常低下与细胞外容量扩张和心肺功能下降有关。
结果：前瞻性纳入的HF（纽约心脏协会II-III级）患者被分层为左心室射血分数[LVEF]保留≥45％的HF，LVEF降低。通过心血管磁共振量化心室形态/功能和心肌细胞外容积（ECV）分数，通过超声心动图的整体纵向应变，来自123碘-间碘苄基胍闪烁显像的心脏与纵隔比率的心脏交感神经功能。所有参与者都接受了心肺运动测试。该队列包括33例LVEF保留的HF患者（LVEF，60±10%；NT-proBNP[N末端B型利钠肽前体]，248[四分位数间距，79-574]pg/dL)，28具有降低的LVEF的HF（LVEF，30±9%;NT-proBNP,743[四分位间距,250-2054]pg/dL）和20个对照（LVEF，65±5%;NT-proBNP,40[四分位距，19-50]pg/dL)。延迟（4小时）123碘-间碘苄基胍心脏与纵隔的比率在LVEF保留的HF（1.59±0.25）和LVEF降低的HF（1.45±0.16）中低于对照组（1.92±0.24；P<0.001），与ECV评估的弥漫性纤维化呈负相关（R=-0.34，P<0.01）。与对照组（0.28±0.04，P<0.05）相比，无LGE节段的ECV在射血分数保留的HF（0.32±0.05％）和左心室射血分数降低的HF（0.31±0.04％）中增加，并且与年龄和性别调整的最大耗氧量（峰值耗氧量）；（R=-0.41，P<0.01）。初步分析表明，心脏交感神经功能可能是ECV和NT-proBNP水平之间关联的介质。
结论：LVEF降低和保留的HF患者心交感神经功能异常低下与细胞外容量扩张和心肺功能下降有关。
