Cardiac adrenergic nerve function in patients with cardiac syndrome X

Antonio Di Monaco, Isabella Bruno, Maria Lucia Calcagni, Roberto Nerla, Priscilla Lamendola, Lucy Barone, Giancarla Scalone, Roberto Mollo, Ilaria Coviello, Antonio Bagnato, Alfonso Sestito, Alessandro Giordano, Gaetano A. Lanza, Filippo Crea

Research output: Contribution to journalArticlepeer-review


Background: We previously found a severe impairment of cardiac uptake of I-metaiodobenzylguanidine (MIBG), an analogue of norepinephrine, on myocardial scintigraphy in a small group of patients with cardiac syndrome X (CSX), suggesting a dysfunction of cardiac adrenergic nerve fibres. In this study, we assessed the consistency of these previous findings in a larger group of these patients. Methods: Planar and single-photon emission computed tomography MIBG myocardial scintigraphy was performed in 40 CSX patients (58 ± 7 years, 17 men). Cardiac MIBG uptake was measured by the heart/mediastinum ratio and by a single-photon emission computed tomography regional cardiac MIBG uptake defect score (higher values = lower uptake). As a control group, we studied 20 healthy individuals (56 ± 6 years, nine men). An exercise stress Tc-SestaMIBI myocardial scintigraphy was performed in 34 CSX patients (85%). Results: Cardiac MIBG defects were observed in 30 patients (75%), with nine (22.5%) showing no cardiac MIBG uptake at all. Compared with controls, CSX patients showed a significantly lower heart/mediastinum ratio (1.70 ± 0.35 vs. 2.1 ± 0.22, P <0.001) and a higher cardiac MIBG defect score (27 ± 25 vs. 4.4 ± 2.5, P <0.001). No differences were found in lung MIBG uptake between the two groups. Reversible perfusion defects on stress myocardial scintigraphy were found in 17 out of 34 CSX patients (50%), all of whom also had abnormal cardiac MIBG uptake; cardiac MIBG uptake abnormalities were also present in nine of 17 patients with normal perfusion scintigraphic images. Cardiac MIBG uptake findings were similar in our first 12 patients and in the 28 patients studied subsequently. Conclusion: Our data show a relevant impairment of cardiac MIBG uptake in patients with CSX, suggesting that functional abnormalities in cardiac adrenergic nerve function may play a significant role in the mechanisms responsible for the syndrome.

Original languageEnglish
Pages (from-to)151-156
Number of pages6
JournalJournal of Cardiovascular Medicine
Issue number3
Publication statusPublished - Mar 2010

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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