title: Significance of cardiac sympathetic nervous system abnormality for predicting vascular events in patients with idiopathic paroxysmal atrial fibrillation.
abstract: OBJECTIVE
  Neuronal system activity plays an important role for the prognosis of patients with atrial fibrillation (AF). Using (123)I metaiodobenzylguanidine ((123)I-MIBG) scintigraphy, we investigated whether a cardiac sympathetic nervous system (SNS) abnormality would be associated with an increased risk of vascular events in patients with paroxysmal AF.
  
  
  METHODS
  (123)I-MIBG scintigraphy was performed in 69 consecutive patients (67 + or - 13 years, 62% men) with paroxysmal AF who did not have structural heart disease. SNS integrity was assessed from the heart to mediastinum (H/M) ratio on delayed imaging. Serum concentration of C-reactive protein (CRP) was measured before (123)I-MIBG study.
  
  
  RESULTS
  During a mean of 4.5 + or - 3.6 years follow-up, 19 patients had myocardial infarction, stroke or heart failure (range: 0.2-11.5 years). SNS abnormality (H/M ratio <2.7) and high CRP (> or = 0.3 mg/dl) were associated with the vascular events (58.3% in 14 of 24 patients with SNS abnormality vs 11.1% in 5 of 45 patients without SNS abnormality, p < 0.0001, 52.4% in 11 of 21 patients with high CRP vs 16.7% in 8 of 48 patients without high CRP, p < 0.0001). After adjustment for potential confounding variables such as age, left atrial dimension and left ventricular function, SNS abnormality was an independent predictor of vascular events with a hazard ratio of 4.1 [95% confidence interval (CI): 1.3-12.6, p = 0.014]. Further, SNS abnormality had an incremental and additive prognostic power in combination with high CRP with an adjusted hazard ratio of 4.1 (95% CI: 1.5-10.9, p = 0.006).
  
  
  CONCLUSIONS
  SNS abnormality is predictive of vascular events in patients with idiopathic paroxysmal AF.
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo 142-8666, Japan. hzn01233@s02.itscom.net
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Akutsu
authors.forename: Kyouichi
authors.initials: K
authors.lastname: Kaneko
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kodama
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Li
authors.forename: Jumpei
authors.initials: J
authors.lastname: Suyama
authors.forename: Akira
authors.initials: A
authors.lastname: Shinozuka
authors.forename: Takehiko
authors.initials: T
authors.lastname: Gokan
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Kawamura
authors.forename: Taku
authors.initials: T
authors.lastname: Asano
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hamazaki
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tanno
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D002097:C-Reactive Protein / Q000032:analysis; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D007457:Iodine Radioisotopes; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012306:Risk; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D013564:Sympathetic Nervous System / Q000503:physiopathology*
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D002097:C-Reactive Protein