1. Serial changes in cardiac sympathetic nervous function after transcatheter aortic valve replacement: A prospective observational study using 123I-meta-iodobenzylguanidine imaging
- Author
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Shunsuke Nakamura, Masaki Yashige, Kan Zen, Takeshi Nakamura, Michiyo Yamano, Nagara Tamaki, Satoaki Matoba, Satoshi Numata, Kazuaki Takamatsu, Tetsuhiro Yamano, Yoshito Kadoya, Nobuyasu Ito, Tomotaka Fujimoto, Hitoshi Yaku, and Hidetake Kawajiri
- Subjects
Aortic valve ,medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Meta iodobenzylguanidine ,Hemodynamics ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,Valve replacement ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Observational study ,Washout rate ,Cardiology and Cardiovascular Medicine ,business - Abstract
Purpose:Transcatheter aortic valve replacement (TAVR) can rapidly improve cardiac sympathetic nervous function (CSNF) within 2 weeks in patients with aortic stenosis (AS). However, it remains unclear whether such short-term improvements will be sustained thereafter. The present study aimed to investigate the mid-term (i.e., 6–12 months) effects of TAVR on CSNF in patients with severe AS using 123I-meta-iodobenzylguanidine (MIBG) imaging.Methods:Patients with severe AS who were scheduled to undergo TAVR between October 2017 and June 2019 were enrolled in this single-centre, prospective, observational study. MIBG imaging was performed at baseline, within 2 weeks after TAVR, and at 6–12 months post-TAVR to evaluate the heart–mediastinum ratio (H/M) and washout rate (WR). Differences between each MIBG parameter at three time points were analysed, and factors involved in the long-term improvement in the late H/M were investigated. Results:Of 183 consecutive patients, 75 (19 men; median age: 86 years) were evaluated. The late H/M significantly improved within 2 weeks after TAVR (P=0.041) and further improved over 6–12 months after TAVR (P=0.041). The WR rapidly improved immediately after TAVR (P=0.003) but remained unchanged at 6–12 months (P=0.827). Multivariate analysis revealed that the baseline mean aortic valve pressure gradient (mPG) was an independent predictor of mid-term improvement in the late H/M (>0.1) (adjusted odds ratio: 0.035; 95% confidence interval: 0.004–0.070; P=0.037). Patients with a high baseline mPG (≥58 mmHg) exhibited a significantly greater increase in the late H/M than those with a low baseline mPG (P=0.029).Conclusions:CSNF, as denoted by the late H/M, demonstrated sustained improvement from within 2 weeks after TAVR until 6–12 months later. Such improvement was related to baseline hemodynamic AS severity.
- Published
- 2021