RT Journal Article
SR Electronic
T1 Myocardial Sympathetic Innervation in Patients with Symptomatic Coronary Artery Disease: Follow-up After 1 Year with Neurostimulation
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1458
OP 1464
DO 10.2967/jnumed.108.052340
VO 49
IS 9
A1 Eva Fricke
A1 Siegfried Eckert
A1 Aristidis Dongas
A1 Harald Fricke
A1 Rainer Preuss
A1 Oliver Lindner
A1 Dieter Horstkotte
A1 Wolfgang Burchert
YR 2008
UL http://jnm.snmjournals.org/content/49/9/1458.abstract
AB In both diabetic and nondiabetic patients, there is a loose correlation between coronary flow reserve (CFR) and sympathetic innervation in viable myocardial segments. The loose correlation implies that sympathetic innervation may be preserved even with major impairment of myocardial blood supply. In some patients, denervation is due to repetitive episodes of ischemia in areas with severely reduced CFR. We investigated the long-term effect of reduced CFR on myocardial sympathetic innervation in diabetic and nondiabetic patients with spinal cord stimulation. Methods: We analyzed 23 patients (10 diabetic and 13 nondiabetic) with coronary artery disease and without known cardiac autonomic neuropathy. At baseline, we determined quantitative myocardial blood flow using 13N-ammonia PET, myocardial viability using 18F-FDG PET, and cardiac innervation using 11C-hydroxyephedrine (HED) PET. At the 1-y follow-up we measured CFR and 11C-HED retention. During follow-up, no cardiac intervention was performed and no myocardial infarction occurred. In all patients, spinal cord stimulation was performed for relief of angina. Results: There was no significant difference in segmental 11C-HED retention between baseline and follow-up in the whole patient group. In diabetic patients, as well as in segments with severely reduced CFR (<1.5), 11C-HED retention showed a small but significant decrease (P < 0.05). Linear regression of segmental 11C-HED retention between baseline and follow-up was high (r2 = 0.81), confirming good reproducibility of the investigation on the one hand and little change in regional sympathetic innervation on the other hand. Conclusion: In patients with stable chronic coronary artery disease, sympathetic innervation of the myocardium is almost unchanged in both diabetic and nondiabetic patients in a 1-y follow-up. In myocardial segments with severely altered blood supply, a small but significant decrease in 11C-HED retention most probably reflects ischemic neuronal damage. The prognostic relevance of sympathetic denervation in viable myocardium still has to be determined.