RADIONUCLIDE EVALUATION OF CHANGES IN MYOCARDIAL SYMPATHETIC ACTIVITY IN PATIENTS WITH ATRIAL FIBRILLATION AND HEALTHY INDIVIDUALS USING A GAMMA CAMERA ON CZT DETECTORS

Minin S.M., Nikitin N.A., Shabanov V.V., Losik D.A., Mikheenko I.L., Pokushalov E.A., Romanov A.B.

Autonomic nervous system (ANS) of the heart and its sympathetic division, in particular, is one of the key elements in the onset and maintenance of atrial fibrillation (AF). Today, in ra-diological practice, cardiac imaging with a neuronal tracer, in particular, with meta-iod-benzyl-guanidine labelled with iodine-123 123I-mIBG, is actively used for non-invasive eval-uation of the state of sympathetic cardiac activity. The aim of this work was to study the scintigraphic patterns of total uptake and the regional distribution of 123I-mIBG in healthy volunteers and patients with paroxysmal AF with a gamma camera equipped with CZT-detectors. Materials and methods. 15 patients with a paroxysmal form of AF and 15 healthy volunteers were included in the study. The protocol of the study with 123I-mIBG included the intravenous administration of radiopharmaceuticals at a dose of 111-370 MBq and the conduct of studies in 20 minutes (early study) and 4 hours after the injection (delayed study). Results. The median ratio of 123I-mIBG uptake in the heart and mediastinum in the early (Heart Mediastinum Ratio early, HMRe) and delayed (Heart Mediastinum Ratio de-layed, HRMd) phase was comparable in patients and volunteers: HRMe – 1.73 (1.61, 1.83) and 1.61 (1.56, 1.70), respectively, p=0.265; HMRd – 1.81 (1.63, 1.95) and 1.67 (1.64, 1.71), p=0.164. In 93% of patients with AF (14/15), defects in 123I-mIBG uptake in left ventricle (LV) myocardium were detected, whereas in healthy volunteers uptake defects were detect-ed in 53% of cases (8/15, p=0.035). The median of the mIBG uptake defect in delayed scans (Summed mIBG Score delayed, SMSd) was significantly higher in patients than in volun-teers: 6 (3, 10) and 0 (0, 0), p<0,001. Conclusion. SPECT gamma camera with CZT-detectors allows obtaining qualitative tomographic sections of the myocardium and evaluating regional changes in sympathetic innervation of the heart. Patients with paroxysmal AF have more significant regional chang-es in the sympathetic activity of the LV myocardium. Regional changes in sympathetic in-nervation may be early signs of an ANS imbalance in patients with AF and can probably be used to predict the course of the disease.

Meshalkin National Medical Research Center. Ministry of Health of Rus-sian Federation. Moscow, Russia.

 

Keywords: atrial fibrillation, imaging, nuclear imaging, mibg, iodbenzylguanidine.

 

Corresponding author:Minin S.M., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Minin S.M., Nikitin N.A., Shabanov V.V., Losik D.A., Mikheenko I.L., Pokushalov E.A., Roma-nov A.B. Radionuclide evaluation of changes in myocardial sympathetic activity in patients with atrial fibrillation and healthy individuals using a gamma camera on CZT detectors. REJR 2018; 8(2):30-39. DOI:10.21569/2222-7415-2018-8-2-30-39.

Received: 02.04.2018 Accepted: 20.04.2018