title: Cardiac denervation after clinical transmyocardial laser revascularization: short-term and long-term iodine 123-labeled meta-iodobenzylguanide scintigraphic evidence.
abstract: OBJECTIVE
  This study was designed to investigate whether transmyocardial laser revascularization induces myocardial denervation and to correlate this with myocardial perfusion and clinical status.
  
  
  METHODS
  Transmyocardial laser revascularization was performed with a Holmium:YAG (n = 3) or xenon chloride excimer laser (n = 5). Preoperative and postoperative iodine 123-labeled meta-iodobenzylguanide SPECT scintigraphy to assess cardiac innervation and perfusion scintigraphy were also performed. Furthermore, New York Heart Association functional angina class and quality of life were assessed.
  
  
  RESULTS
  In all patients postoperative iodine 123-labeled meta-iodobenzylguanide SPECT showed significantly decreased uptake and therefore sympathetic myocardial denervation at up to 16 months' follow-up (average preoperative and postoperative summed defect scores of 14.8 +/- 5.3 and 24.5 +/- 4.2, respectively; P =.00005). In 86% of segments, the decreased meta-iodobenzylguanide uptake could be correlated to the treated area. In all patients angina was reduced by 2 or more classes at 12 months' follow-up, and quality of life improved significantly.
  
  
  CONCLUSIONS
  Transmyocardial laser revascularization-induced improvement of angina and quality of life can be explained by destruction of nociceptors or cardiac neural pathways, changing the perception of anginal pain.
authors.affiliation: Laser Center, Academic Medical Center, University of Amsterdam, The Netherlands. j.f.beek@amc.uva.nl
authors.forename: Johan F
authors.initials: JF
authors.lastname: Beek
authors.forename: Jos A P
authors.initials: JA
authors.lastname: van der Sloot
authors.forename: Menno
authors.initials: M
authors.lastname: Huikeshoven
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Verberne
authors.forename: Berthe L F
authors.initials: BL
authors.lastname: van Eck-Smit
authors.forename: Jan
authors.initials: J
authors.lastname: van der Meulen
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Martin J C
authors.initials: MJ
authors.lastname: van Gemert
authors.forename: Raymond
authors.initials: R
authors.lastname: Tukkie
mesh_terms: D019797:3-Iodobenzylguanidine; D000787:Angina Pectoris / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging / Q000294:innervation*; D006801:Humans; D007457:Iodine Radioisotopes; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D009204:Myocardial Revascularization; D010147:Pain Measurement; D011788:Quality of Life; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D016032:Randomized Controlled Trials as Topic; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013995:Time; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine