背景:局部心肌交感神经支配在慢性恰加斯心肌病(CCC)患者中是一种明显的早期疾病,目的:在一项纵向研究中,评估CCC中局部心肌交感神经支配的存在和进展与整体和节段性左心室功能障碍恶化之间的关系。
方法:18例CCC患者在初始评估时和5.5年后接受了123碘代碘代苄基胍和99mTc-司他米比的心肌闪烁显像和二维超声心动图评估心肌交感神经支配,纤维化程度,左心室射血分数(LVEF)和室壁运动异常。
结果:在后续评估中,与最初的相比,我们观察到LVEF显著降低(56±11~49%±12;P=.01),心肌神经支配显像的总缺损评分增加(15±10~20±9;P<.01).在可行的非纤维化心肌的心室区域存在局部心肌交感神经支配,新的壁运动异常的发展的比值比为4.25(P=.001)。
结论:局部和整体心肌交感神经支配是CCC的进行性紊乱。此外,区域去神经支配在地形上与CCC患者区域收缩功能障碍的未来发展区域相关。
Regional myocardial sympathetic denervation is a conspicuous and early disorder in patients with chronic Chagas\' cardiomyopathy (CCC), potentially associated to the progression of myocardial dysfunction OBJECTIVE: To evaluate in a longitudinal study the association between the presence and the progression of regional myocardial sympathetic denervation with the deterioration of global and segmental left ventricular dysfunction in CCC.
18 patients with CCC were submitted at initial evaluation and after 5.5 years to rest myocardial scintigraphy with 123Iodo-metaiodobenzylguanidine and 99mTc-sestamibi and to two-dimensional echocardiography to assess myocardial sympathetic denervation, extent of fibrosis, and the left ventricular ejection fraction (LVEF) and wall motion abnormalities.
In the follow-up evaluation, compared to the initial one, we observed a significant decrease in LVEF (56 ± 11 to 49% ± 12; P = .01) and increased summed defects scores in the myocardial innervation scintigraphy (15 ± 10 to 20 ± 9; P < .01). The presence of regional myocardial sympathetic denervation in ventricular regions of viable non-fibrotic myocardium presented an odds ratio of 4.25 for the development of new wall motion abnormalities (P = .001).
Regional and global myocardial sympathetic denervation is a progressive derangement in CCC. In addition, the regional denervation is topographically associated with areas of future development of regional systolic dysfunction in patients with CCC.