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Cardiac Sympathetic Dysfunction Correlates With Abnormal Myocardial Contractile Reserve in Dilated Cardiomyopathy Patients

Satoru Ohshima, MD^_*, Satoshi Isobe, MD, PhD^_*,_*, Hideo Izawa, MD, PhD^_*, Mamoru Nanasato, MD, PhD^_*, Akitada Ando, MD, PhD^_*, Akira Yamada, MD^_*, Kiyoyasu Yamada, MD, PhD^_*, Tomoko S. Kato, MD, PhD^_*, Koji Obata, PhD, Akiko Noda, PhD, Takao Nishizawa, MD, Katsuhiko Kato, MD, PhD, Kohzo Nagata, MD, PhD, Kenji Okumura, MD, PhD^_*, Toyoaki Murohara, MD, PhD^_* and Mitsuhiro Yokota, MD, PhD, FACC

^_* Department of Cardiology, Nagoya University School of Medicine, Nagoya, Japan
Department of Cardiovascular Genome Science, Nagoya University School of Medicine, Nagoya, Japan
Department of Medical Technology, Nagoya University School of Health Science, Nagoya, Japan
Department of Radiology, Nagoya University Hospital, Nagoya, Japan.

View larger version (10K): [in a new window]   Figure 1 Relationship between the delayed iodine-123-metaiodobenzylguanidine heart-mediastinum ratio (HMR) and the percentage change in LV dP/dtmax from the baseline to the peak or critical heart rate. LV dP/dtmax = maximum first derivative of left ventricular pressure.

View larger version (36K): [in a new window]   Figure 2 A representative case of a 50-year-old woman. Left ventricular ejection fraction (LVEF) is 35%, and this patient is in New York Heart Association (NYHA) functional class II. (A) Increased lung uptake and severely reduced myocardial uptake are observed on the delayed 123I-MIBG planar image. The delayed HMR is 1.4. (B) The relationship between heart rate (HR) and LV dP/dtmax of this patient is shown. The baseline LV dP/dtmax and maximum LV dP/dtmax are 1,107 mm Hg/s and 1,284 mm Hg/s, respectively. The percentage change in LV dP/dtmax from the baseline to the critical HR is 10%. A biphasic pattern of change in LV dP/dtmax is observed. bpm = beats per minute; other abbreviations as in Figure 1.

View larger version (42K): [in a new window]   Figure 3 A case of a 60-year-old man. LVEF is 45%, and this patient is in NYHA functional class I. (A) Mildly reduced myocardial uptake is observed in the inferior wall on the delayed 123I-MIBG planar image. The delayed HMR is 2.0. (B) The relationship between HR and LV dP/dtmax of this patient is shown. The baseline LV dP/dtmax and maximum LV dP/dtmax are 1,224 mm Hg/s and 1,509 mm Hg/s, respectively. The percentage change in LV dP/dtmax from the baseline to the peak HR is 27%. A progressively increasing pattern of change in LV dP/dtmax is observed. Abbreviations as in Figures 1 and 2.