Myocardial Sympathetic Innervation in Patients with Symptomatic Coronary Artery Disease: Follow-up After 1 Year with Neurostimulation

Fricke, Eva; Eckert, Siegfried; Dongas, A.; Fricke, Harald; Preuss, R.; Lindner, Oliver; Horstkotte, Dieter; Burchert, Wolfgang

doi:10.2967/jnumed.108.052340

Cited by 14 publications

(11 citation statements)

References 30 publications

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“…48,49 Our findings are consistent with improvement in SN function after CPAP therapy. Whether this translates into a meaningful clinical outcome benefit requires further investigation and was not within the scope of the present study.…”

Section: Impact Of Cpap Therapy On Myocardial Sns Activity In Patientsupporting

confidence: 80%

Effects of Short-Term Continuous Positive Airway Pressure on Myocardial Sympathetic Nerve Function and Energetics in Patients With Heart Failure and Obstructive Sleep Apnea

et al. 2014

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O bstructive sleep apnea (OSA), present in approximately a third of all patients with heart failure (HF) with reduced ejection fraction (HFrEF), [1][2][3] is an independent predictor of mortality. 4 Common to both HFrEF and OSA are sympathetic nervous system (SNS) activation and impaired myocardial energetic efficiency. Clinical Perspective on p 901Myocardial efficiency estimates the capacity of the heart to convert oxygen into effective forward stroke work.5-9 The noninvasively derived cardiac work metabolic index (WMI) estimates efficiency by quantifying forward minute-work of the Background-Heart failure with reduced ejection fraction and obstructive sleep apnea (OSA), 2 states of increased metabolic demand and sympathetic nervous system activation, often coexist. Continuous positive airway pressure (CPAP), which alleviates OSA, can improve ventricular function. It is unknown whether this is due to altered oxidative metabolism or presynaptic sympathetic nerve function. We hypothesized that short-term (6-8 weeks) CPAP in patients with OSA and heart failure with reduced ejection fraction would improve myocardial sympathetic nerve function and energetics. Methods and Results-Forty-five patients with OSA and heart failure with reduced ejection fraction (left ventricular ejection fraction 35.8±9.7% [mean±SD]) were evaluated with the use of echocardiography and 11 C-acetate and 11 C-hydroxyephedrine positron emission tomography before and ≈6 to 8 weeks after randomization to receive short-term CPAP (n=22) or no CPAP (n=23). Work metabolic index, an estimate of myocardial efficiency, was calculated as follows: (stroke volume index×heart rate×systolic blood pressure÷K mono ), where K mono is the monoexponential function fit to the myocardial ; P=0.003). There was no significant change in work metabolic index between groups. However, in those with more severe OSA (apnea-hypopnea index >20 events per hour), CPAP significantly increased both work metabolic index and systolic blood pressure (P<0.05). Conclusions-In patients with heart failure with reduced ejection fraction and OSA, short-term CPAP increased hydroxyephedrine retention, indicating improved myocardial sympathetic nerve function, but overall did not affect energetics. In those with more severe OSA, CPAP may improve cardiac efficiency. Further outcome-based investigation of the consequences of CPAP is warranted. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00756366.(Circulation. 2014;130:892-901.)

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Section: Impact Of Cpap Therapy On Myocardial Sns Activity In Patientsupporting

confidence: 80%

Effects of Short-Term Continuous Positive Airway Pressure on Myocardial Sympathetic Nerve Function and Energetics in Patients With Heart Failure and Obstructive Sleep Apnea

et al. 2014

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“…Since regional norepinephrine uptake is only moderately reduced in hibernating myocardium6,7 as compared to infarction11,12 or cardiac transplantation,13,14 we have hypothesized that the partially dysinnervated myocardium may reflect a functional abnormality of the nerves rather than denervation 8. Although previous studies of patients with chronic coronary artery disease have shown very limited potential for improvement in regional dysinnervation,11,15,16 this could have been the result of denervation associated with unrecognized infarction. In contrast, we hypothesized that the sympathetic dysinnervation associated with the reversible ischemia in hibernating myocardium6,7 may result from a functional, ischemically mediated inhibition of the norepinephrine reuptake mechanism.…”

Section: Introductionmentioning

confidence: 99%

11C-meta-hydroxyephedrine defects persist despite functional improvement in hibernating myocardium

Fallavollita

Banas

Suzuki

et al. 2010

Journal of Nuclear Cardiology

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“…In line with preclinical findings, patients with multi-vessel disease and prior revascularization, but without a history of MI, show significant impairments in [ 11 C]-HED uptake compared to normal controls, despite having normal resting MBF [71]. Furthermore, there have been reports of reduced [ 11 C]-HED uptake in a similar pattern to stress-flow defects in patients with CAD, but with viable myocardium [62]. …”

Section: Alterations In Autonomic Function With Myocardial Ischemia Amentioning

confidence: 69%

“…These studies also showed that decrements in [ 11 C]-HED uptake were especially evident in patients with non-Q wave infarctions and were irreversible at short-term follow-up. Some studies using [ 11 C]-HED [62] have corroborated the irreversibility of post-infarct denervation, although studies with [ 18 F]-6F-DA have not [63]. …”

Section: Alterations In Autonomic Function With Myocardial Ischemia Amentioning

confidence: 99%

Recent Advances and Clinical Applications of PET Cardiac Autonomic Nervous System Imaging

Boutagy

Sinusas

2017

Curr Cardiol Rep

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Purpose of Review The purpose of this review was to summarize current advances in positron emission tomography (PET) cardiac autonomic nervous system (ANS) imaging, with a specific focus on clinical applications of novel and established tracers. Recent Findings [11C]-Meta-hydroxyephedrine (HED) has provided useful information in evaluation of normal and pathological cardiovascular function. Recently, [11C]-HED PET imaging was able to predict lethal arrhythmias, sudden cardiac death (SCD), and all-cause mortality in heart failure patients with reduced ejection fraction (HFrEF). In addition, initial [11C]-HED PET imaging studies have shown the potential of this agent in elucidating the relationship between impaired cardiac sympathetic nervous system (SNS) innervation and the severity of diastolic dysfunction in HF patients with preserved ejection fraction (HFpEF) and in predicting the response to cardiac resynchronization therapy (CRT) in HFrEF patients. Longer half-life 18F-labeled presynaptic SNS tracers (e.g., [18F]-LMI1195) have been developed to facilitate clinical imaging, although no PET radiotracers that target the ANS have gained wide clinical use in the cardiovascular system. Although the use of parasympathetic nervous system radiotracers in cardiac imaging is limited, the novel tracer, [11C]-donepezil, has shown potential utility in initial studies. Summary Many ANS radioligands have been synthesized for PET cardiac imaging, but to date, the most clinically relevant PET tracer has been [11C]-HED. Recent studies have shown the utility of [11C]-HED in relevant clinical issues, such as in the elusive clinical syndrome of HFpEF. Conversely, tracers that target cardiac PNS innervation have been used less clinically, but novel tracers show potential utility for future work. The future application of [11C]-HED and newly designed 18F-labeled tracers for targeting the ANS hold promise for the evaluation and management of a wide range of cardiovascular diseases, including the prognostication of patients with HFpEF.

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Myocardial Sympathetic Innervation in Patients with Symptomatic Coronary Artery Disease: Follow-up After 1 Year with Neurostimulation

Cited by 14 publications

References 30 publications

Effects of Short-Term Continuous Positive Airway Pressure on Myocardial Sympathetic Nerve Function and Energetics in Patients With Heart Failure and Obstructive Sleep Apnea

Effects of Short-Term Continuous Positive Airway Pressure on Myocardial Sympathetic Nerve Function and Energetics in Patients With Heart Failure and Obstructive Sleep Apnea

11C-meta-hydroxyephedrine defects persist despite functional improvement in hibernating myocardium

Recent Advances and Clinical Applications of PET Cardiac Autonomic Nervous System Imaging

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