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

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Abstract

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
Volume11
Issue number3
DOIs
Publication statusPublished - Mar 2010

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Microvascular Angina
Adrenergic Agents
Myocardial Perfusion Imaging
Mediastinum
Single-Photon Emission-Computed Tomography
Perfusion
Adrenergic Fibers
Nerve Fibers

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Di Monaco, A., Bruno, I., Calcagni, M. L., Nerla, R., Lamendola, P., Barone, L., ... Crea, F. (2010). Cardiac adrenergic nerve function in patients with cardiac syndrome X. Journal of Cardiovascular Medicine, 11(3), 151-156. https://doi.org/10.2459/JCM.0b013e328330321d

Cardiac adrenergic nerve function in patients with cardiac syndrome X. / Di Monaco, Antonio; Bruno, Isabella; Calcagni, Maria Lucia; Nerla, Roberto; Lamendola, Priscilla; Barone, Lucy; Scalone, Giancarla; Mollo, Roberto; Coviello, Ilaria; Bagnato, Antonio; Sestito, Alfonso; Giordano, Alessandro; Lanza, Gaetano A.; Crea, Filippo.

In: Journal of Cardiovascular Medicine, Vol. 11, No. 3, 03.2010, p. 151-156.

Research output: Contribution to journalArticle

Di Monaco, A, Bruno, I, Calcagni, ML, Nerla, R, Lamendola, P, Barone, L, Scalone, G, Mollo, R, Coviello, I, Bagnato, A, Sestito, A, Giordano, A, Lanza, GA & Crea, F 2010, 'Cardiac adrenergic nerve function in patients with cardiac syndrome X', Journal of Cardiovascular Medicine, vol. 11, no. 3, pp. 151-156. https://doi.org/10.2459/JCM.0b013e328330321d
Di Monaco A, Bruno I, Calcagni ML, Nerla R, Lamendola P, Barone L et al. Cardiac adrenergic nerve function in patients with cardiac syndrome X. Journal of Cardiovascular Medicine. 2010 Mar;11(3):151-156. https://doi.org/10.2459/JCM.0b013e328330321d
Di Monaco, Antonio ; Bruno, Isabella ; Calcagni, Maria Lucia ; Nerla, Roberto ; Lamendola, Priscilla ; Barone, Lucy ; Scalone, Giancarla ; Mollo, Roberto ; Coviello, Ilaria ; Bagnato, Antonio ; Sestito, Alfonso ; Giordano, Alessandro ; Lanza, Gaetano A. ; Crea, Filippo. / Cardiac adrenergic nerve function in patients with cardiac syndrome X. In: Journal of Cardiovascular Medicine. 2010 ; Vol. 11, No. 3. pp. 151-156.
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abstract = "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.",
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AU - Bruno, Isabella

AU - Calcagni, Maria Lucia

AU - Nerla, Roberto

AU - Lamendola, Priscilla

AU - Barone, Lucy

AU - Scalone, Giancarla

AU - Mollo, Roberto

AU - Coviello, Ilaria

AU - Bagnato, Antonio

AU - Sestito, Alfonso

AU - Giordano, Alessandro

AU - Lanza, Gaetano A.

AU - Crea, Filippo

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N2 - 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.

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