title: Sleep-disordered breathing, impaired cardiac adrenergic innervation and prognosis in heart failure.
abstract: OBJECTIVE
  Unfavourable effects of sleep-disordered breathing (SDB) in heart failure (HF) are mainly mediated by impaired sympathetic activity. Few data are available on SDB and cardiac adrenergic impairment evaluated at myocardial level. The aim of the study was to assess the relationship between SDB, cardiac sympathetic innervation assessed by123I-metaiodobenzylguanidine (123I-MIBG) imaging and prognosis in HF.
  
  
  METHODS
  Observational, prospective study enrolling patients with HF and reduced systolic function. Patients underwent nocturnal cardiorespiratory monitoring to assess SDB presence by apnoea/hypopnoea index (AHI), and123I-MIBG imaging to calculate heart-to-mediastinum (H/M) ratios and washout rate. Patients were prospectively followed for 29±18 months for the combined endpoint of cardiovascular death and HF hospitalisation.
  
  
  RESULTS
  Ninety-four patients (66.1±9.8 years; left ventricular ejection fraction 32±7%) were enrolled; 72 (77%) showed SDB and, compared with non-SDB, significantly reduced early (1.67±0.22 vs 1.77±0.13; p=0.019) and late H/M ratios (1.50±0.22 vs 1.61±0.23; p=0.038). Dividing patients into two groups according to SDB severity, patients with a moderate-severe disturbance (AHI >15; n=43) showed significantly worse survival for the composite study outcome (log-rank test, p=0.001) with respect to patients with mild or no disorder (AHI ≤15; n=51). Adding SDB variables to the already known prognostic role of123I-MIBG imaging, we observed a worse survival in patients with both SDB and H/M impairment.
  
  
  CONCLUSIONS
  Patients with systolic HF and SDB show more impaired cardiac adrenergic innervation assessed by123I-MIBG imaging, and more adverse prognosis compared with HF patients without SDB.
authors.affiliation: Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy.|Cardiovascular Department, IRCCS MultiMedica, Sesto San Giovanni, Italy.
authors.forename: Oriana
authors.initials: O
authors.lastname: Scala
authors.affiliation: SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Paolillo
authors.affiliation: Department of Translational Medical Sciences, Section of Geriatrics, Federico II University, Naples, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Formisano
authors.affiliation: Department of Advanced Biomedical Sciences, Section of Imaging, Radiotherapy, Neuroradiology and Medical Physics, Federico II University, Naples, Italy.|Institute of Biostructures and Bioimages of the National Council of Research, Naples, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Pellegrino
authors.affiliation: Department of Translational Medical Sciences, Section of Geriatrics, Federico II University, Naples, Italy.|Division of Cardiology, "Salvatore Maugeri" Foundation-IRCCS-Institute of Telese Terme (BN), Telese Terme, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rengo
authors.affiliation: SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Gargiulo
authors.affiliation: Dipartimento Onco-Pneumo-Ematologia, UOC Pneumologia 1 e Fisiopatologia Respiratoria, AORN A. Cardarelli, Naples, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: De Michele
authors.affiliation: Dipartimento Onco-Pneumo-Ematologia, UOC Pneumologia 1 e Fisiopatologia Respiratoria, AORN A. Cardarelli, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Starace
authors.affiliation: Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rapacciuolo
authors.affiliation: Department of Translational Medical Sciences, Section of Geriatrics, Federico II University, Naples, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Parisi
authors.affiliation: Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Prastaro
authors.affiliation: Department of Advanced Biomedical Sciences, Section of Imaging, Radiotherapy, Neuroradiology and Medical Physics, Federico II University, Naples, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Piscopo
authors.affiliation: Istituto Diagnostico Varelli, Naples, Italy.
authors.forename: Santo
authors.initials: S
authors.lastname: Dellegrottaglie
authors.affiliation: Department of Public Health, Federico II University, Naples, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Bruzzese
authors.affiliation: Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: De Martino
authors.affiliation: Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Parente
authors.affiliation: Department of Translational Medical Sciences, Section of Geriatrics, Federico II University, Naples, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Leosco
authors.affiliation: Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.affiliation: SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy.|Department of Advanced Biomedical Sciences, Section of Imaging, Radiotherapy, Neuroradiology and Medical Physics, Federico II University, Naples, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cuocolo
authors.affiliation: Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Perrone-Filardi