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Comparison of Cardiac Sympathetic Nervous Function with Left Ventricular Function and Perfusion in Cardiomyopathies by ¹²³I-MIBG SPECT and ^99mTc-Tetrofosmin Electrocardiographically Gated SPECT

Department of Radiology and First Department of Internal Medicine, Asahikawa Medical College; and Section of Radiology, Asahikawa Medical College Hospital, Asahikawa, Japan

The objective of this study was to clarify the relationship between cardiac sympathetic nervous function (CSNF) and left ventricular (LV) function and perfusion in hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). Methods: Thirty-eight cases (32 males, 6 females; mean age, 56 ± 15 y), consisting of 5 healthy control subjects, 15 patients with DCM, and 18 patients with HCM, were studied with ¹²³I-metaiodobenzylguanidine (MIBG) and ^99mTc-tetrofosmin SPECT. CSNF was evaluated from cardiac uptake and washout of MIBG, whereas LV perfusion and function were evaluated from tetrofosmin uptake and wall thickening on electrocardiographically gated SPECT. As quantitative parameters of global cardiac MIBG uptake and washout, the heart-to-mediastinum ratio (H/M) and percentage washout were calculated from early and delayed planar images. As quantitative regional parameters, the regional uptake and percentage washout of MIBG were calculated from SPECT images dividing the left ventricle into 12 segments. In the tetrofosmin study, the H/M and LV ejection fraction were calculated as the parameters of global LV perfusion and function. As quantitative regional parameters, the regional uptake and wall thickening were also calculated for the 12 myocardial segments using the quantitative gated SPECT software. Multiple linear regression analysis was performed to investigate the correlations between the parameters from the 2 studies. Results: In DCM and HCM, multiple linear regression analysis of the regional parameters showed significant correlations between LV function and CSNF (P < 0.0001) and between LV perfusion and CSNF (P < 0.0001). According to the partial correlation coefficients, washout and early uptake of MIBG were the most significant factors for predicting LV function and LV perfusion, respectively. Conclusion: In cardiomyopathies, CSNF was closely related to LV function. The quantitative parameters of MIBG washout could reflect cardiac functional impairment. Early MIBG uptake might be determined by myocardial perfusion in cardiomyopathies.

Key Words: hypertrophic cardiomyopathy • dilated cardiomyopathy • ¹²³I-metaiodobenzylguanidine • ^99mTc-tetrofosmin • gated myocardial SPECT

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