[Evaluation of the sympathetic nervous system in silent ischemia with 123I-metaiodobenzylguanidine (MIBG)].
OBJECTIVE
Examination of the integrity of the sympathetic nervous system in patients with angiographically proven coronary artery disease and ECG documented asymptomatic ST-segment depression.


METHODS
Stress and rest myocardial perfusion scintigraphy using either Thallium-201 or 99mTc-isonitrile was performed in SPECT technique in order to localize ischemia or scar associated perfusion defects. 15 min and 4 h p.i. static anterior 123I-MIBG uptake was acquired. In order to localize norepinephrine depletion 4 h p.i. additional 123I-MIBG SPECT acquisition was performed. Incidence of arrhythmias was investigated by Holter ECG. Patients with diabetes mellitus were excluded.


RESULTS
SPECT images showed in all patients regional 123I-MIBG depletion which corresponded with scintigraphically infarcted or ischemic regions. Well perfused myocardial regions matched with regular 123I-MIBG uptake. There was no evidence of increased arrhythmias in long-term ECG.


CONCLUSIONS
The finding of regular 123I-MIBG uptake in well-perfused myocardium and infarction- or ischemia-associated regional 123I-MIBG depletion confirms that silent ischemia is not caused by a global sympathetic nervous dysfunction in a sense of cardiac polyneuropathy.
Gürtner
C
C
Abteilung Nuklearmedizin, Universitätsklinikum Frankfurt am Main, Deutschland.
Schacherer
C
C
Krause
B J
BJ
Zickmann
J
J
Klepzig
H
H
Hör
G
G
D019797:3-Iodobenzylguanidine; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000503:physiopathology; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics; D007462:Iodobenzenes / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D013794:Thallium Radioisotopes; D019797:3-Iodobenzylguanidine