Heart 1999;81:262-270 ( March )

Regional patterns of myocardial sympathetic denervation in dilated cardiomyopathy: an analysis using carbon-11 hydroxyephedrine and positron emission tomography

F Hartmann,^a S Ziegler,^c S Nekolla,^c M Hadamitzky,^b M Seyfarth,^b G Richardt,^a M Schwaiger^c

^a Medizinische Klinik II, Medizinische Universität zu Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany, ^b 1. Medizinische Klinik, Klinikum rechts der Isar, TU München, München, Germany, ^c Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, TU München, München, Germany

Correspondence to: Dr Hartmann. email: hartmann{at}medinf.muluebeck.de

Accepted for publication 13 October 1998

OBJECTIVETo assess presynaptic function of cardiac autonomic innervation in patients with advanced congestive heart failure using positron emission tomography (PET) and the recently developed radiolabelled catecholamine analogue carbon-11 hydroxyephedrine (HED) as a marker for neuronal catecholamine uptake function.
DESIGN AND PATIENTS29 patients suffering from dilated cardiomyopathy with moderate to severe heart failure were compared with eight healthy controls. Perfusion scan was followed by HED dynamic PET imaging of cardiac sympathetic innervation. The scintigraphic results were compared with markers of disease severity and the degree of sympathetic dysfunction assessed by means of heart rate variability.
RESULTSIn contrast to nearly normal perfusions, mean (SD) HED retention in dilated cardiomyopathy patients was abnormal in 64 (32)% of the left ventricle. Absolute myocardial HED retention was 10.7 (1.0)%/min in controls v 6.2 (1.6)%/min in dilated cardiomyopathy patients (p < 0.001). Moreover, significant regional reduction of HED retention was demonstrated in apical and inferoapical segments. HED retention was significantly correlated with New York Heart Association functional class (r = 0.55, p = 0.002) and ejection fraction (r = 0.63, p < 0.001), but not, however, with plasma noradrenaline concentrations as well as parameters of heart rate variability.
CONCLUSIONSIn this study, using PET in combination with HED in patients with dilated cardiomyopathy, not only global reduction but also regional abnormalities of cardiac sympathetic tracer uptake were demonstrated. The degree of abnormality was positively correlated to markers of severity of heart failure. The pathogenetic mechanisms leading to the regional differences of neuronal damage as well as the prognostic significance of these findings remain to be defined.

Keywords: heart failure; dilated cardiomyopathy; C-11 hydroxyephedrine; positron emission tomography; sympathetic nervous system

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© 1999 by Heart
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