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Early effects of transcatheter aortic valve replacement on cardiac sympathetic nervous function assessed by 123I-metaiodobenzylguanidine scintigraphy in patients with severe aortic valve stenosis

  • Yoshito Kadoya
  • Kan ZenEmail author
  • Nagara Tamaki
  • Nobuyasu Ito
  • Kensuke Kuwabara
  • Michiyo Yamano
  • Tetsuhiro Yamano
  • Takeshi Nakamura
  • Shigenori Matsushima
  • Katsuhiko Oka
  • Satoshi Numata
  • Hitoshi Yaku
  • Satoaki Matoba
Original Article
  • 32 Downloads
Part of the following topical collections:
  1. Cardiology

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

123I-Metaiodobenzylguanidine scintigraphy Cardiac sympathetic nervous Aortic valve stenosis Transcatheter aortic valve replacement 

Abbreviations

AS

Aortic valve stenosis

LV

Left ventricular

TAVR

Transcatheter aortic valve replacement

CSN

Cardiac sympathetic nervous

MIBG

123I-Metaiodobenzylguanidine

mPG

Mean aortic valve pressure gradient

Vmax

Peak velocity

AVA

Aortic valve area;

H/M

Heart–mediastinum ratio

WR

Washout rate

Notes

Author Contribution

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Yoshito Kadoya
    • 1
  • Kan Zen
    • 1
    Email author
  • Nagara Tamaki
    • 2
  • Nobuyasu Ito
    • 1
  • Kensuke Kuwabara
    • 1
  • Michiyo Yamano
    • 1
  • Tetsuhiro Yamano
    • 1
  • Takeshi Nakamura
    • 1
  • Shigenori Matsushima
    • 2
  • Katsuhiko Oka
    • 3
  • Satoshi Numata
    • 3
  • Hitoshi Yaku
    • 3
  • Satoaki Matoba
    • 1
  1. 1.Department of Cardiovascular Medicine, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
  2. 2.Department of Radiology, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
  3. 3.Department of Cardiovascular SurgeryKyoto Prefectural University of MedicineKyotoJapan

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