Early effects of transcatheter aortic valve replacement on cardiac sympathetic nervous function assessed by 123I-metaiodobenzylguanidine scintigraphy in patients with severe aortic valve stenosis
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The effects of transcatheter aortic valve replacement (TAVR) on cardiac sympathetic nervous (CSN) function have not been fully explored. This study aimed to investigate the early (within 2 weeks) effects of TAVR on CSN function in patients with severe aortic valve stenosis (AS) using 123I-metaiodobenzylguanidine (MIBG) scintigraphy.
Of 143 consecutive patients who were scheduled to undergo TAVR, 67 (18 men; median age 86 years) were evaluated in this single-centre prospective observational study. MIBG scintigraphy was performed at baseline and 3–14 days after the TAVR procedure to evaluate the heart–mediastinum ratio (H/M) and washout rate (WR). Differences between baseline and post-TAVR MIBG parameters were analysed. MIBG parameter changes were compared with echocardiographic parameters. Furthermore, factors involved in the improvement in MIBG parameters were investigated.
All patients successfully underwent TAVR with improved echocardiographic parameters, including aortic valve area (AVA; 0.6 cm2 vs. 1.6 cm2), peak velocity (4.5 m/s vs. 2.0 m/s), mean pressure gradient (50 mmHg vs. 9 mmHg), and left ventricular ejection fraction (56% vs. 62%) (all p < 0.001). On MIBG imaging, delayed H/M significantly increased (2.57 vs. 2.68, p < 0.001), whereas WR decreased (32.2% vs. 26.8%, p < 0.001). In multivariate analysis, higher baseline WR was associated with improvement in WR (> 3%). Female sex, Clinical Frailty Scale score ≤ 5, baseline estimated glomerular filtration rate, and baseline AVA were predictors of improvement in delayed H/M (> 0.1). Baseline AVA and E/E′ were independent predictors of improvement in both WR and delayed H/M.
The CSN function was impaired in patients with AS, as assessed using MIBG scintigraphy. WR and delayed H/M improved immediately after TAVR. Improvement in CSN function may be related to echocardiographic AS severity at baseline before TAVR.
Keywords123I-Metaiodobenzylguanidine scintigraphy Cardiac sympathetic nervous Aortic valve stenosis Transcatheter aortic valve replacement
Aortic valve stenosis
Transcatheter aortic valve replacement
Cardiac sympathetic nervous
Mean aortic valve pressure gradient
Aortic valve area;
Yoshito Kadoya collected data, performed statistical analysis, and wrote the manuscript. Kan Zen, Nagara Tamaki, Michiyo Yamano, Tetsuhiro Yamano, Takeshi Nakamura, Shigenori Matsushima, and Satoaki Matoba revised the manuscript and figures. Nobuyasu Ito and Kensuke Kuwabara collected data and revised the manuscript. Katsuhiko Oka, Satoshi Numata, and Hitoshi Yaku revised the manuscript. All the authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures were performed in accordance with the ethical standards of the institutional research committee of Kyoto Prefectural University of Medicine (no. ERB-C-1081-1) and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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