Volume 111, Nº2, August 2018
DOI: http://www.dx.doi.org/10.5935/abc.20180124
ORIGINAL ARTICLE
Sympathetic Dysautonomia in Heart Failure by 123I-MIBG: comparison between Chagasic, non-Chagasic and heart transplant patients
Viviane Santuari Parisotto Marino
Sandra Monetti Dumont
Luciene das Graças Mota
Daniela de Souza Braga
Stephanie Saliba de Freitas
Maria da Consolação Vieira Moreira
Figure 1 – Early (15-minute) and late (180-minute) anterior planar imaging of the chest by 123I-MIBG scintigraphy, with regions of interest (ROI) positioned on the superior mediastinum between the pulmonary fields and heart.
Abstract
Background: Heart failure (HF) is a severe public health problem because of its high morbidity and mortality and elevated costs, thus requiring better understanding of its course. In its complex and multifactorial pathogenesis, sympathetic hyperactivity plays a relevant role. Considering that sympathetic dysfunction is already present in the initial phases of chronic Chagas cardiomyopathy (CCC) and frequently associated with a worse prognosis, we assumed it could be more severe in CCC than in cardiomyopathies of other etiologies (non-CCC).
Objectives: To assess the cardiac sympathetic dysfunction (123I-MIBG) of HF, comparing individuals with CCC to those with non-CCC, using heart transplant (HT) patients as denervated heart parameters.
Methods: We assessed 76 patients with functional class II-VI HF, being 25 CCC (17 men), 25 non-CCC (14 men) and 26 HT (20 men), by use of cardiac 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy, estimating the early and late heart-to-mediastinum ratio (HMR) of 123I-MIBG uptake and cardiac washout (WO%). The 5% significance level was adopted in the statistical analysis.
Results: The early and late HMR values were 1.73 ± 0.24 and 1.58 ± 0.27, respectively, in CCC, and 1.62 ± 0.21 and 1.44 ± 0.16 in non CCC (p = NS), being, however, higher in HT patients (p < 0.001). The WO% values were 41.65 ± 21.4 (CCC), 47.37 ± 14.19% (non-CCC) and 43.29 ± 23.02 (HT), p = 0.057. The late HMR values showed a positive weak correlation with left ventricular ejection fraction (LVEF) in CCC and non-CCC (r = 0.42 and p = 0.045; and r = 0.49 and p = 0.015, respectively).
Conclusion: Sympathetic hyperactivity (123I-MIBG) was evidenced in patients with class II-IV HF, LVEF < 45%, independently of the HF etiology, as compared to HT patients. (Arq Bras Cardiol. 2018; 111(2):182-190)
Keywords: Heart Failure; Primary Dysautonomies; Chagas Cardiomyopathy; Myocardial/radionuclide imaging; 123I-metaiodobenzylguanidine (123I-MIBG).
