Copyright © 2001 by the European Society of Cardiology.
Relationship between altered sympathetic innervation, oxidative metabolism and contractile function in the cardiomyopathic human heart; a non-invasive study using positron emission tomography
a Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Germany
b Abteilung Innere Medizin, Kreiskrankenhaus Fürstenfeldbruck, Germany
c I. Medizinische Klinik der Technischen Universität München, Germany
revised November 27, 2000; accepted November 28, 2000
Abstract
Aims To identify functional and metabolic correlates of impaired presynaptic sympathetic innervation in the cardiomyopathic human heart using non-invasive correlative imaging.
Methods and Results In 10 patients with idiopathic dilated cardiomyopathy, presynaptic catecholamine uptake sites were quantified by positron emission tomography with C-11 hydroxyephedrine. Oxidative metabolism was measured using C-11 acetate. Global and regional function was assessed by tomographic radionuclide angiography. Left ventricular ejection fraction in patients was 19%±10%. Myocardial hydroxyephedrine retention was abnormally low in 58%±38% of the left ventricles. Globally and regionally, hydroxyephedrine retention was significantly correlated with ventricular function (r=0·67, P=0·03 with left ventricular ejection fraction; r=0·31, P<0·01 with regional endocardial shortening). Multivariate analysis confirmed hydroxyephedrine retention as the closest independent determinant of left ventricular ejection fraction. Oxidative metabolism was determined by rate pressure product as a measure of workload (r=0·78, P<0·01) and peripheral vascular resistance as a measure of afterload (r=–0·61, P=0·06), but did not correlate with hydroxyephedrine retention (r=0·08 for global, r=0·04 for regional parameters).
Conclusion Alterations of presynaptic sympathetic innervation in dilated cardiomyopathy are associated with impaired contractile function, suggesting a common pathogenetic pathway. Overall oxidative metabolism, however, was not directly correlated with these findings. Normal regulatory mechanisms for oxidative metabolism were operational.
Key Words: Positron emission tomography, autonomic nervous system, oxidative metabolism, heart failure, left ventricular function
f1 Correspondence: Frank M. Bengel, MD, Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 München, Germany.
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