Impaired Myocardial Sympathetic Innervation Is Associated with Diastolic Dysfunction in Heart Failure with Preserved Ejection Fraction:11C-Hydroxyephedrine PET Study.
Diastolic dysfunction is important in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Sympathetic nervous hyperactivity may contribute to the development of diastolic dysfunction. The aim of this study was to determine the relationship between myocardial sympathetic innervation quantified by11C-hydroxyephedrine PET and diastolic dysfunction in HFpEF patients.Methods:Forty-one HFpEF patients having an echocardiographic left ventricular ejection fraction of 40% or greater and 12 age-matched volunteers without heart failure underwent the echocardiographic examination and11C-hydroxyephedrine PET. Diastolic dysfunction was classified into grades 0-3 by Doppler echocardiography. Myocardial sympathetic innervation was quantified using the11C-hydroxyephedrine retention index (RI). The coefficient of variation of 17-segment RIs was derived as a measure of heterogeneity in myocardial11C-hydroxyephedrine uptake.Results:Grade 2-3 diastolic dysfunction (DD2-3) was found in 19 HFpEF patients (46%). They had a significantly lower global RI (0.075 ± 0.018 min-1) than volunteers (0.123 ± 0.028 min-1,P< 0.001) and HFpEF patients with grade 0-1 diastolic dysfunction (DD0-1) (0.092 ± 0.024 min-1,P= 0.046). HFpEF patients with DD2-3had the largest coefficient of variation of 17-segment RIs of the 3 groups (18.4% ± 7.7% vs. 14.1% ± 4.7% in HFpEF patients with DD0-1,P= 0.042 for post hoc tests). In multivariate logistic regression analysis, a lower global RI (odds ratio, 0.66 per 0.01 min-1; 95% confidence interval, 0.38-0.99;P= 0.044) was independently associated with the presence of DD2-3in HFpEF patients.Conclusion:Myocardial sympathetic innervation was impaired in HFpEF patients and was associated with the presence of advanced diastolic dysfunction in HFpEF.
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Tadao
T
Aikawa
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan naya@med.hokudai.ac.jp.
Masanao
M
Naya
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Masahiko
M
Obara
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Osamu
O
Manabe
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Yuuki
Y
Tomiyama
Department of Medical Imaging, Hokkaido University Hospital, Sapporo, Japan; and.
Keiichi
K
Magota
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Satoshi
S
Yamada
Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.
Chietsugu
C
Katoh
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Nagara
N
Tamaki
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Hiroyuki
H
Tsutsui
D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D004809:Ephedrine / Q000031:analogs & derivatives*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology
D019275:Radiopharmaceuticals; C065363:3-hydroxyephedrine; D004809:Ephedrine
11C-hydroxyephedrine; diastolic dysfunction; heart failure with preserved ejection fraction