title: Prognostic Significance of Neuroadrenergic Dysfunction for Cardiovascular Events in Patients With Acute Myocardial Infarction.
abstract: BACKGROUND
  The dysregulation of systemic blood pressure (BP) variation or cardiac neuroadrenergic dysfunction is associated with adverse cardiovascular events. We aimed to clarify the prognostic significance of neuroadrenergic dysfunction for cardiovascular events in patients with acute myocardial infarction (AMI).
  
  
  RESULTS
  We enrolled 63 AMI patients (mean age, 67±12 years) underwent ambulatory BP monitoring (ABPM) and cardiac iodine-(123)metaiodobenzylguanidine (MIBG) imaging within 4 weeks after AMI onset. We analyzed the circadian BP pattern and heart-to-mediastinum (H/M) MIBG uptake ratio. All the patients were followed for 2 years. The study endpoint was a composite of major adverse cardiovascular events, including all-cause death, MI, coronary revascularization except for the MI culprit lesion, and stroke. Patients with a non-dipper pattern (n=29) or an H/M ratio <1.96 (n=28) had a worse prognosis than those with either a dipper pattern (n=34) or an H/M ratio ≥1.96 (n=35; log-rank, P=0.013 and 0.010, respectively). Patients with both a non-dipper pattern and an H/M ratio <1.96 (n=12) had a significantly worse prognosis than did the other patients (P=0.0020).
  
  
  CONCLUSIONS
  Dysregulation of BP variation and cardiac MIBG uptake were associated with cardiovascular events following AMI. Examining ABPM with MIBG imaging may potentially improve risk stratification in these patients.
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Minamisawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Izawa
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Motoki
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kashima
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Hioki
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Abe
authors.forename: Takashi
authors.initials: T
authors.lastname: Miura
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ebisawa
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Miyashita
authors.forename: Jun
authors.initials: J
authors.lastname: Koyama
authors.forename: Uichi
authors.initials: U
authors.lastname: Ikeda
mesh_terms: D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology