Little is known about the relation between left ventricular (LV) functional reserve in response to exercise and cardiac sympathetic nervous function in patients with nonobstructive hypertrophic cardiomyopathy (HCM). We investigated whether an assessment of cardiac sympathetic nervous function by myocardial 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy might provide a sign of an abnormal LV functional reserve in response to exercise-induced β-adrenergic stimulation in patients with HCM. Methods: Thirty HCM patients underwent 123I-MIBG scintigraphy and echocardiography at rest and subsequent biventricular cardiac catheterization at rest and during dynamic exercise. LV pressures were measured using a micromanometer-tipped catheter system. The early and delayed 123I-MIBG images were quantified as a heart-to-mediastinum ratio (H/M). The plasma levels of brain natriuretic peptide (BNP) and norepinephrine (NE) were also measured. Results: Patients were divided into 2 groups according to the delayed 123I-MIBG H/M: group I consisted of 12 patients with a delayed H/M of ≤ 1.8 and group II had 18 patients with a delayed H/M of > 1.8. Both the percentage increase from rest to exercise in LV isovolumic contraction (LV dP/dtmax) and the percentage shortening of LV pressure half-time (T1/2) as an index of isovolumic relaxation were significantly less in group I than in group II (P < 0.05, respectively). A significant linear correlation was observed between the percentage increase in LV dP/dtmax and 123I-MIBG H/Ms (early H/M: r = 0.49, P < 0.01; delayed H/M: r= 0.54, P < 0.005, respectively). A significant linear correlation was also observed between the percentage shortening in T 1/2 and 123I-MIBG H/Ms (early H/M: r = 0.58, P < 0.001; delayed H/M: r = 0.64, P < 0.0005, respectively). The plasma NE levels were significantly higher in group I than in group II (P < 0.01), whereas the plasma BNP levels were comparable in the 2 HCM groups. Conclusion: β-Adrenergic enhancement of LV function during exercise may depend on the extent of cardiac sympathetic nervous innervation in HCM patients. Resting myocardial 123I-MIBG scintigraphy can noninvasively evaluate LV functional reserve in response to exercise in patients with nonobstructive HCM.
|ジャーナル||Journal of Nuclear Medicine|
|出版ステータス||Published - 01-12-2005|
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