Untersuchungen des sympathischen Nervensystems bei stummer Ischämie mit ¹²³J-Metajodbenzylguanidin (MIBG)

Zusammenfassung

Ziel: Untersuchung der sympathiko-adrenergen Innnervation bei Patienten mit koronarangiographisch dokumentierter KHK und EKG-gesicherter asymptomatischer ST-Senkung. Methode: Thallium-201 oder ^99mTc-Isonitril Myokard-SPECT-Szintigraphie wurde in Ruhe und unter Belastung zur Erfassung des ischämischer Areale oder Narben durchgeführt. 15 min und 4 h p.l. erfolgte die Akquisition des statischen anterioren ¹²³J-MIBG-Uptakes. 4 h p.i. wurde zusätzlich eine ¹²³J-MIBG SPECT Akquisition zur Lokalisation der Katecholamindefekte durchgeführt. Zur Evaluierung von Rhythmusstörungen erfolgten Langzeit-EKG-Untersuchungen. Patienten mit Diabetes mellitus wurden ausgeschlossen. Ergebnisse: Alle Patienten boten regionale ¹²³J-MIBG-Defekte, die myokardszintigraphisch mit Narbe oder Ischämie korrespondierten. Nicht ischämisches, gut perfundiertes Myokard zeigte einen regelrechten ¹²³J-MIBG-Uptake. Das Langzeit-EKG ergab keinen Hinweis auf vermehrte Arrhythmien. Schlußfolgerung: Die Ergebnisse bestätigen eine regionale Ischämie- bzw. Narbe-assoziierte Denervierung bei sonst regelrechter sympathischer Innervation. Eine globale periphere sympathische Innervationsstörung im Sinne einer Polyneuropathie scheint somit bei der stummen Ischämie nicht vorzuliegen.

Summary

Aim: Examination of the integrity of the sympathetic nervous system in patients with angiographically proven coronary artery disease and ECG documented asymptomatic ST-segment depression. Method: Stress and rest myocardial perfusion scintigraphy using either Thallium-201 or ^99mTc-isonitrile was performed in SPECT technique in order to localize ischemia or scar associated perfusion defects. 15 min and 4 h p.i. static anterior ¹²³I-MIBG uptake was acquired. In order to localize norepinephrine depletion 4 h p.i. additional ¹²³I-MIBG SPECT acquisition was performed. Incidence of arrhythmias was investigated by Holter ECG. Patients with diabetes mellitus were excluded. Results: SPECT images showed in all patients regional ¹²³I-MIBG depletion which corresponded with scintigraphically infarcted or ischemic regions. Well perfused myocardial regions matched with regular ¹²³I-MIBG uptake. There was no evidence of increased arrhythmias in long-term ECG. Conclusion: The finding of regular ¹²³I-MIBG uptake in well-perfused myocardium and infarction- or ischemia-associated regional ¹²³I-MIBG depletion confirms that silent ischemia is not caused by a global sympathetic nervous dysfunction in a sense of cardiac polyneuropathy.

Schlüsselwörter

Stumme Ischämie - Neurotransmitterszintigraphie - ¹²³J-MIBG

Keywords

Silent ischemia - neurotransmitter scintigraphy - ¹²³I-MIBG

^* Abteilung Kardiologie, Universitätsklinikum Frankfurt am Main, Deutschland

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