Circulation, Vol 79, 634-644, Copyright © 1989 by American Heart Association
MW Dae, JW O'Connell, EH Botvinick, T Ahearn, E Yee, JP Huberty, H Mori, MC Chin, RS Hattner and JM Herre
To assess the feasibility of noninvasively imaging the regional
distribution of myocardial sympathetic innervation, we evaluated the
distribution of sympathetic nerve endings, using 123I
metaiodobenzylguanidine (MIBG), and compared this with the distribution of
myocardial perfusion, using 201Tl. Twenty dogs were studied: 11 after
regional denervation, and nine as controls. Regional denervation was done
by left stellate ganglion removal, right stellate ganglion removal, and
application of phenol to the epicardial surface. Computer- processed
functional maps displayed the relative distribution of MIBG and thallium in
multiple projections in vivo and excised heart slices in all animals. In
six animals, dual isotope emission computed tomograms were acquired in
vivo. Tissue samples taken from innervated and denervated regions of the
MIBG images were analyzed for norepinephrine content to validate image
findings. Normal controls showed homogeneous and parallel distributions of
MIBG and thallium in the major left ventricular mass. In the left
stellectomized hearts, MIBG was reduced relative to thallium in the
posterior left ventricle; whereas in right stellectomized hearts, reduced
MIBG was in the anterior left ventricle. Phenol-painted hearts showed a
broad area of decreased MIBG extending beyond the area of phenol
application. In both stellectomized and phenol-painted hearts, thallium
distribution remained homogeneous and normal. Norepinephrine content was
greater in regions showing normal MIBG (550 +/- 223 ng/g) compared with
regions showing reduced MIBG (39 +/- 44 ng/g) (p less than 0.001),
confirming regional denervation. Combined MIBG-thallium functional maps
display the regional distribution of sympathetic innervation. This new
ability to noninvasively map the distribution of sympathetic nerves with
simultaneous comparison to regional perfusion may provide important new
insights into mechanisms, whereby an imbalance in sympathetic activity may
relate to clinical disorders.
ARTICLES
Scintigraphic assessment of regional cardiac adrenergic innervation
Department of Medicine, University of California, San Francisco 94143.
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