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Improvement of sympathetic innervation, in patients with heart failure, undergoing bone marrow transplantation
Journal of Nuclear Cardiology Volume 12, Number 2
Abstracts Monday, May 9, 2005
S3
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1.11
Stability of cardiac sympathetic denervation but progression of cardiomyopathy in familial amyloid polyneuropathy 2 years after liver transplantation. N. Nicolas Delahaye1, S. Dinanian2, MS. Slama2, L. Sarda1, C. Tamas3, F. Rouzet1, D. Samuel4, D. Adams5, A. Syrota3, D. Le Guludec.1 1Hopital Bichat, Service de Me´decine Nucle´aire, Paris, France, 2Hoˆpital A Be´cle`re, Service de Cardiologie, PARIS, France, 3DRM, DSV-CEA, SHFJ, Orsay, France, 4Hoˆpital P. Brousse, Service de Chirurgie He´patique, Paris, France, 5Hoˆpital Bice`tre, Service de Neurologie, Paris, France
Evaluation of intracoronary bone marrow transplantation, in patients with heart failure, by Thallium-201 scintigraphy. M. Maria Koutelou1, N. Kollaros1, A. Theodorakos1, A. Kouzoumi1, A. Manginas2, E. Goussetis3, V. Tsapaki4, D. Cokkinos.2 1Onassis Cardiac Center, Nuclear Medicine, Athens, Greece, 2Onassis Cardiac Surgery Center, 1st Cardiology Dept., Athens, Greece, 3Aghia Sofia Children’s Hospital, SCT unit, Athens, Greece, 4Aghia Olga Hospital, Radiology Dept., Athens, Greece
Familial amyloid polyneuropathy (FAP) is a rare and severe hereditary form of amyloidosis, due to amyloid deposition of a genetic variant transthyretin essentially produced by the liver, and characterized by both sensorimotor and autonomic neuropathy. The only effective treatment is liver transplantation (LT). The disease usually does not induce heart failure but is associated with conduction disturbances and sudden death. Cardiac denervation has been demonstrated, but its time-course post LT is not known. Cardiac sympathetic denervation assessed by iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy, heart rate variability (HRV) analysis and echocardiography were longitudinally achieved in 31 patients with FAP (age, 39⫾12 years; left ventricular ejection fraction, 67⫾7%) before and after LT (24⫾15 months). Cardiac MIBG uptake was markedly decreased in patients compared with age-matched control subjects (heart-to-mediastinum activity ratio at 4 hours, 1.45⫾0.29 versus 1.98⫾0.35, P⬍0.001), with no change after LT (1.46⫾0.28, NS). On SPET images, defects were diffuse in 12 patients and localized in 19 patients, with predominance at the inferior and apical segments, with less extensive defects in 4 patients but more in 2 patients after LT. HRV non spectral indexes were also stable after LT. Left ventricular wall thickness was slightly increased with a significant worsening after LT. Neurological status was stabilized in 26 patients, worsened in the 5 patients who had the lowest cardiac MIBG uptake. Conduction disturbances and ventricular arrhythmias were associated with low cardiac MIBG uptake. In conclusion, cardiac sympathetic denervation and HRV remain stable 2 years after LT in FAP, with no sign of early reinnervation, but with progression of cardiac amyloid infiltration. Low cardiac MIBG uptake seems to be a prognostic factor of neurological status worsening after LT.
Background: Results of experimental studies have shown that intramyocardial or intracoronary administration of bone marrow stem cells (BMSC) improves heart function after myocardial infarction. This study evaluate the hypothesis that intracoronary infusion of BMSC in patients (pts), could improve myocardial perfusion. Methods and results: Six male patients with an old non-viable anterior myocardial infarction (dating 32⫾19 months) were include in the study. The left ventricular ejection fraction was 29⫾5%. The pts were transplanted with autologous BMSC via a baloon catheter placed into the infarct-related (LAD) artery (BMSC number 15.6⫾8.5x106). Tl-201 myocardial perfusion images were acquired a few days pre and 3 months post transplantation. The two studies were compared by calculating the counts of short axis slices. Images were assessed by quantitative measures of the activity in the area at risk, compared to normal segments for both studies. Two regions of interest (ROI) were drawn for each image. The first for the normal and the second for the abnormal segment of myocardium. The ratio (r), wich is defined as the counts per pixel of normal ROI to the counts per pixel to abnormal ROI, was calculated. The value of r was 2.66⫾0.6 and 2.33⫾0.7, p value of 0.039, for pre and post transplantation studies correspondingly. Conclusions: The significant decrease of r ratio indicates that myocardial perfusion was improved after the BMSC transplantation. This fact might be assosiated with myocardial regeneration and revascularization.
1.10
1.12
Tomographic radionuclide ventriculography vs Tl-201 gated SPECT in the assessment of segmental myocardial contractility. E. Efstratios Moralidis1, T. Spyridonidis2, G. Arsos1, N. Karatzas1, K. Karakatsanis.1 1 Hippokration Hospital, Thessaloniki, Greece, 2Rio Hospital, Patras, Greece
Improvement of sympathetic innervation, in patients with heart failure, undergoing bone marrow transplantation. M. Maria Koutelou1, A. Theodorakos1, N. Kollaros1, A. Manginas2, S. Graphakos3, V. Tsapaki4, A. Kouzoumi1, D. Cokkinos.2 1Onassis Cardiac Center, Nuclear Medicine, Athens, Greece, 2Onassis Cardiac Surgery Center, 1st Cardiology Dept., Athens, Greece, 3Aghia Sofia Children’s Hospital, SCT unit, Athens, Greece, 4Aghia Olga Hospital, Radiology Dept., Athens, Greece
Aim: this study compares the assessment of regional myocardial contractility by tomographic radionuclide ventriculography (SPECT-RNV) and gated SPECT Tl-201 (Tl-GSP). Method: eighteen patients (16 male, 2 female), aged 59 ⫾ 8 years, with angiographically established coronary artery disease (10 with a history of acute myocardial infarction), referred for exercise myocardial perfusion imaging, were recruited. 1.2MBq/kgr Tl-201 (range 80-110) was injected at peak stress followed by early and delayed Tl-GSP acquisitions. Subsequently, patients were submitted to SPECT-RNV (740 MBq 99mTc-RBC). Myocardial outline was divided into 9 segments (basal and distal portions of the 4 walls and the apex. Tl-201 uptake (% of maximum) was assessed in both early and delayed Tl-GSP acquisitions together with regional contractility (good, hypokinesis, a-/dys-kinesis) in both Tl-GSP acquisitions and SPECT-RNV. All assessments were performed by two independent observers, consensus reached when required.Cohen’s kappa statistic was used in comparisons. Results: the assessment of segmental contractility is presented in table 1. Conclusion: In the assessment of regional myocardial contractility the agreement between SPECT-RNV and Tl-GSP appears unsatisfactory. In detail, the agreement between these techniques: 1) Is fair to moderate in segments with Tl-201 uptake ⬎50%. 2) Is poor in segments with Tl-201 uptake ⬍50%.
Table 1. early Tl-GSP
delayed Tl-GSP
⬍50% segmental Tl-201 uptake SPECT-RNV good hypokinesis akinesis good hypokinesis akinesis good 95 16 1 98 14 0 hypokinesis 4 4 2 7 8 6 akinesis 2 2 2 1 2 4 kappa⫽0.28 (SEE 0.09) kappa⫽0.41 (SEE 0.08) ⬍50% segmental Tl-201 uptake SPECT-RNV good hypokinesis akinesis good hypokinesis akinesis good 8 0 8 4 0 3 hypokinesis 2 2 10 1 0 8 akinesis 0 2 2 0 2 4 kappa⫽0.13 (SEE0.09) kappa⫽0.10 (SEE0.12)
Aim: The aim of this study was to assess the sympathetic innervation in patients (pts) with chronic heart failure after bone marrow stem cell (BMSC) transplantation. Recent reports suggest that intracoronary BMSC administration may contribute to the healing of myocardial infarction and therefore to sympathetic innervation. We analyzed the results of 4 pts underwent I-123-MIBG myocardial scintigraphy pre and post cell transplantation. Methods and results: 4 male pts with an old non-viable infarction (dating 32⫾19 months) were included in the study. The left ventricular enjection fraction was 29⫾5%. The BMSC were slowly delivered into the proximal left anterior descending artery (LAD) (BMSC number 15.6⫾8.5⫻106), via a baloon catheter. We studied the pts a few days pre and 3 months post transplantation, using I-123-MIBG myocardial scintigraphy. Images were aquired 4 hours post injection for all pts. We compared the two studies for each pt and calculated the counts from short axis slices. The images were assessed by quantitative measures of the activity in the decreased activity area, compared to normal segments for both studies. Two regions of interest (ROI) were selected for each image. The first for the normal and the second for abnormal segment of myocardium. The ratio r of counts per pixel of normal ROI to counts per pixel of abnormal ROI was calculated. The r value was 1.72 ⫾0.2 and 1.29⫾0.2, p value of 0.078, for pre and post transplantation studies, correspondingly. Conclusions: We observe that the r ratio decreases significantly after BMSC transplantation. This fact suggests that this ratio can be used as a critirio for BMSC which might be associated with improvement in myocardial sympathetic innervation and therefore better prognosis.
M O N D M A O Y N D M A A Y Y M 9 A Y 9
Abstracts Monday, May 9, 2005
S3
1.9
1.11
Stability of cardiac sympathetic denervation but progression of cardiomyopathy in familial amyloid polyneuropathy 2 years after liver transplantation. N. Nicolas Delahaye1, S. Dinanian2, MS. Slama2, L. Sarda1, C. Tamas3, F. Rouzet1, D. Samuel4, D. Adams5, A. Syrota3, D. Le Guludec.1 1Hopital Bichat, Service de Me´decine Nucle´aire, Paris, France, 2Hoˆpital A Be´cle`re, Service de Cardiologie, PARIS, France, 3DRM, DSV-CEA, SHFJ, Orsay, France, 4Hoˆpital P. Brousse, Service de Chirurgie He´patique, Paris, France, 5Hoˆpital Bice`tre, Service de Neurologie, Paris, France
Evaluation of intracoronary bone marrow transplantation, in patients with heart failure, by Thallium-201 scintigraphy. M. Maria Koutelou1, N. Kollaros1, A. Theodorakos1, A. Kouzoumi1, A. Manginas2, E. Goussetis3, V. Tsapaki4, D. Cokkinos.2 1Onassis Cardiac Center, Nuclear Medicine, Athens, Greece, 2Onassis Cardiac Surgery Center, 1st Cardiology Dept., Athens, Greece, 3Aghia Sofia Children’s Hospital, SCT unit, Athens, Greece, 4Aghia Olga Hospital, Radiology Dept., Athens, Greece
Familial amyloid polyneuropathy (FAP) is a rare and severe hereditary form of amyloidosis, due to amyloid deposition of a genetic variant transthyretin essentially produced by the liver, and characterized by both sensorimotor and autonomic neuropathy. The only effective treatment is liver transplantation (LT). The disease usually does not induce heart failure but is associated with conduction disturbances and sudden death. Cardiac denervation has been demonstrated, but its time-course post LT is not known. Cardiac sympathetic denervation assessed by iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy, heart rate variability (HRV) analysis and echocardiography were longitudinally achieved in 31 patients with FAP (age, 39⫾12 years; left ventricular ejection fraction, 67⫾7%) before and after LT (24⫾15 months). Cardiac MIBG uptake was markedly decreased in patients compared with age-matched control subjects (heart-to-mediastinum activity ratio at 4 hours, 1.45⫾0.29 versus 1.98⫾0.35, P⬍0.001), with no change after LT (1.46⫾0.28, NS). On SPET images, defects were diffuse in 12 patients and localized in 19 patients, with predominance at the inferior and apical segments, with less extensive defects in 4 patients but more in 2 patients after LT. HRV non spectral indexes were also stable after LT. Left ventricular wall thickness was slightly increased with a significant worsening after LT. Neurological status was stabilized in 26 patients, worsened in the 5 patients who had the lowest cardiac MIBG uptake. Conduction disturbances and ventricular arrhythmias were associated with low cardiac MIBG uptake. In conclusion, cardiac sympathetic denervation and HRV remain stable 2 years after LT in FAP, with no sign of early reinnervation, but with progression of cardiac amyloid infiltration. Low cardiac MIBG uptake seems to be a prognostic factor of neurological status worsening after LT.
Background: Results of experimental studies have shown that intramyocardial or intracoronary administration of bone marrow stem cells (BMSC) improves heart function after myocardial infarction. This study evaluate the hypothesis that intracoronary infusion of BMSC in patients (pts), could improve myocardial perfusion. Methods and results: Six male patients with an old non-viable anterior myocardial infarction (dating 32⫾19 months) were include in the study. The left ventricular ejection fraction was 29⫾5%. The pts were transplanted with autologous BMSC via a baloon catheter placed into the infarct-related (LAD) artery (BMSC number 15.6⫾8.5x106). Tl-201 myocardial perfusion images were acquired a few days pre and 3 months post transplantation. The two studies were compared by calculating the counts of short axis slices. Images were assessed by quantitative measures of the activity in the area at risk, compared to normal segments for both studies. Two regions of interest (ROI) were drawn for each image. The first for the normal and the second for the abnormal segment of myocardium. The ratio (r), wich is defined as the counts per pixel of normal ROI to the counts per pixel to abnormal ROI, was calculated. The value of r was 2.66⫾0.6 and 2.33⫾0.7, p value of 0.039, for pre and post transplantation studies correspondingly. Conclusions: The significant decrease of r ratio indicates that myocardial perfusion was improved after the BMSC transplantation. This fact might be assosiated with myocardial regeneration and revascularization.
1.10
1.12
Tomographic radionuclide ventriculography vs Tl-201 gated SPECT in the assessment of segmental myocardial contractility. E. Efstratios Moralidis1, T. Spyridonidis2, G. Arsos1, N. Karatzas1, K. Karakatsanis.1 1 Hippokration Hospital, Thessaloniki, Greece, 2Rio Hospital, Patras, Greece
Improvement of sympathetic innervation, in patients with heart failure, undergoing bone marrow transplantation. M. Maria Koutelou1, A. Theodorakos1, N. Kollaros1, A. Manginas2, S. Graphakos3, V. Tsapaki4, A. Kouzoumi1, D. Cokkinos.2 1Onassis Cardiac Center, Nuclear Medicine, Athens, Greece, 2Onassis Cardiac Surgery Center, 1st Cardiology Dept., Athens, Greece, 3Aghia Sofia Children’s Hospital, SCT unit, Athens, Greece, 4Aghia Olga Hospital, Radiology Dept., Athens, Greece
Aim: this study compares the assessment of regional myocardial contractility by tomographic radionuclide ventriculography (SPECT-RNV) and gated SPECT Tl-201 (Tl-GSP). Method: eighteen patients (16 male, 2 female), aged 59 ⫾ 8 years, with angiographically established coronary artery disease (10 with a history of acute myocardial infarction), referred for exercise myocardial perfusion imaging, were recruited. 1.2MBq/kgr Tl-201 (range 80-110) was injected at peak stress followed by early and delayed Tl-GSP acquisitions. Subsequently, patients were submitted to SPECT-RNV (740 MBq 99mTc-RBC). Myocardial outline was divided into 9 segments (basal and distal portions of the 4 walls and the apex. Tl-201 uptake (% of maximum) was assessed in both early and delayed Tl-GSP acquisitions together with regional contractility (good, hypokinesis, a-/dys-kinesis) in both Tl-GSP acquisitions and SPECT-RNV. All assessments were performed by two independent observers, consensus reached when required.Cohen’s kappa statistic was used in comparisons. Results: the assessment of segmental contractility is presented in table 1. Conclusion: In the assessment of regional myocardial contractility the agreement between SPECT-RNV and Tl-GSP appears unsatisfactory. In detail, the agreement between these techniques: 1) Is fair to moderate in segments with Tl-201 uptake ⬎50%. 2) Is poor in segments with Tl-201 uptake ⬍50%.
Table 1. early Tl-GSP
delayed Tl-GSP
⬍50% segmental Tl-201 uptake SPECT-RNV good hypokinesis akinesis good hypokinesis akinesis good 95 16 1 98 14 0 hypokinesis 4 4 2 7 8 6 akinesis 2 2 2 1 2 4 kappa⫽0.28 (SEE 0.09) kappa⫽0.41 (SEE 0.08) ⬍50% segmental Tl-201 uptake SPECT-RNV good hypokinesis akinesis good hypokinesis akinesis good 8 0 8 4 0 3 hypokinesis 2 2 10 1 0 8 akinesis 0 2 2 0 2 4 kappa⫽0.13 (SEE0.09) kappa⫽0.10 (SEE0.12)
Aim: The aim of this study was to assess the sympathetic innervation in patients (pts) with chronic heart failure after bone marrow stem cell (BMSC) transplantation. Recent reports suggest that intracoronary BMSC administration may contribute to the healing of myocardial infarction and therefore to sympathetic innervation. We analyzed the results of 4 pts underwent I-123-MIBG myocardial scintigraphy pre and post cell transplantation. Methods and results: 4 male pts with an old non-viable infarction (dating 32⫾19 months) were included in the study. The left ventricular enjection fraction was 29⫾5%. The BMSC were slowly delivered into the proximal left anterior descending artery (LAD) (BMSC number 15.6⫾8.5⫻106), via a baloon catheter. We studied the pts a few days pre and 3 months post transplantation, using I-123-MIBG myocardial scintigraphy. Images were aquired 4 hours post injection for all pts. We compared the two studies for each pt and calculated the counts from short axis slices. The images were assessed by quantitative measures of the activity in the decreased activity area, compared to normal segments for both studies. Two regions of interest (ROI) were selected for each image. The first for the normal and the second for abnormal segment of myocardium. The ratio r of counts per pixel of normal ROI to counts per pixel of abnormal ROI was calculated. The r value was 1.72 ⫾0.2 and 1.29⫾0.2, p value of 0.078, for pre and post transplantation studies, correspondingly. Conclusions: We observe that the r ratio decreases significantly after BMSC transplantation. This fact suggests that this ratio can be used as a critirio for BMSC which might be associated with improvement in myocardial sympathetic innervation and therefore better prognosis.
M O N D M A O Y N D M A A Y Y M 9 A Y 9