会議発表用資料 Early therapeutic effects of adaptive servo-ventilation on cardiac sympathetic nervous activity in patients with heart failure evaluated by the combined use of 11C-HED PET and 123I-MIBG SPECT

Tokuda, Yusuke  ,  Yoshinaga, Keiichiro  ,  Sakakibara, Mamoru  ,  Yamada, Shiro  ,  Yoshitani, Takashi  ,  Noguchi, Keiji  ,  Manabe, Osamu  ,  Tamaki, Nagara

2017-09-15
内容記述
Background: Adaptive servo-ventilation (ASV), a novel respiratory support therapy for sleep disorders, may improve cardiac function in heart failure (HF), but this possible mechanism has not been fully studied especially in sympathetic nervous activity (SNA). Ideally, SNA measurements should be precise quantifications with both uptake and washout parameters. The purpose of the present study was to investigate early therapeutic effects of ASV therapy on cardiac SNA in patients with HF. We therefore comprehensively evaluated SNA using 11C-hydroxyephedrine (HED) positron emission tomography computed tomography (PET/CT) as a presynaptic function marker and 123I-meta-iodobenzylguanidine single-photon emission computed tomography (123I-MIBG SPECT) as an SNA turnover parameter. Methods: We studied 9 HF patients (57.3 ± 17.3 years old, left ventricular ejection fraction [LVEF] 36.1 ± 16.7%) regardless of the type of sleep disorder. We employed echocardiography, polysomnography, biomarkers, 11C-HED PET and 123I-MIBG SPECT before and after 6 months of ASV therapy. Results: The apnea-hypopnea index (AHI) decreased from 22.3 ± 14.4/h to 1.9 ± 4.1/h (P = 0.004) after 6 months of ASV. The log plasma brain natriuretic peptide (BNP) concentration decreased from 2.48 ± 0.54 pg/mL to 2.07 ± 0.69 pg/mL (P = 0.048). In 123I-MIBG imaging, the early heart/mediastinum (H/M) ratio significantly increased after ASV therapy (2.19 ± 0.58 to 2.40 ± 0.67; P = 0.045). Washout rate did not change (23.8 ± 7.3% to 23.8 ± 8.8%; P = 0.122). Global 11C-HED retention index improved from 0.068 ± 0.033/s to 0.075 ± 0.034/s (P = 0.029). Conclusions: ASV reduced AHI and improved log BNP. ASV therapy also significantly improved early 123I-MIBG H/M ratio and 11C-HED retention index in HF patients. The 123I-MIBG washout ratio did not change. Therefore, ASV might initially improve presynaptic function after 6 months of treatment.
ASNC2017

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