Regional sympathetic denervation after myocardial infarction in humans detected noninvasively using I-123-metaiodobenzylguanidine

• Published in: Journal of the American College of Cardiology Vol. 14; no. 6; pp. 1519 - 1526
• Main Authors: Stanton, Marshall S., Tuli, Mahmoud M., Radtke, Nancy L., Heger, James J., Miles, William M., Mock, Bruce H., Burt, Robert W., Wellman, Henry N., Zipes, Douglas P.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-11-1989; Elsevier Science
• Subjects: 3-Iodobenzylguanidine; 550601 - Medicine- Unsealed Radionuclides in Diagnostics; Adrenergic Fibers - diagnostic imaging; Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac - etiology; BETA DECAY RADIOISOTOPES; Biological and medical sciences; BODY; Cardiology. Vascular system; CARDIOVASCULAR DISEASES; CARDIOVASCULAR SYSTEM; Coronary heart disease; COUNTING TECHNIQUES; DAYS LIVING RADIOISOTOPES; DIAGNOSIS; DIAGRAMS; DISEASES; DRUGS; ELECTROCARDIOGRAMS; Electrocardiography, Ambulatory; ELECTRON CAPTURE RADIOISOTOPES; EXERCISE; Exercise Test; HEART; Heart - innervation; HEAVY NUCLEI; HOURS LIVING RADIOISOTOPES; Humans; INTERMEDIATE MASS NUCLEI; IODINE 123; IODINE ISOTOPES; Iodine Radioisotopes; Iodobenzenes; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; LABELLED COMPOUNDS; Male; Medical sciences; Middle Aged; MYOCARDIAL INFARCTION; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - physiopathology; NERVES; NERVOUS SYSTEM; NUCLEI; ODD-EVEN NUCLEI; ORGANS; PATIENTS; RADIOISOTOPE SCANNING; RADIOISOTOPES; RADIOLOGY AND NUCLEAR MEDICINE; Radionuclide Imaging; RADIOPHARMACEUTICALS; SECONDS LIVING RADIOISOTOPES; Stroke Volume; THALLIUM 201; THALLIUM ISOTOPES; Thallium Radioisotopes; Radionuclide study; Human; Infarct; Arrhythmia; Cardiovascular disease; Scintigraphy; Coronary heart disease; Screening; Risk factor; Myocardium; Paroxysmal ventricular tachycardia; Sympathic nervous system; Denervation
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(89)90391-4

Transmural myocardial infarction in dogs produces denervation of sympathetic nerves in viable myocardium apical to the infarct that may be arrhythmogenic. It is unknown whether sympathetic denervation occurs in humans. The purpose of this study was to use iodine- 123-metaiodobenzylguanidine (MIBG), a radiolabeled guanethidine analog that is actively taken up by sympathetic nerve terminals, to image noninvasively the cardiac sympathetic nerves in patients with and without ventricular arrhythmias after myocardial infarction.
Results showed that 10 of 12 patients with spontaneous ventricular tachyarrhythmias after myocardial infarction exhibited regions of thallium-201 uptake indicating viable perfused myocardium, with no MIBG uptake. Such a finding is consistent with sympathetic denervation. One patient had frequent episodes of nonsustained ventricular tachycardia induced at exercise testing that was eliminated by beta-adrenoceptor blockade. Eleven of the 12 patients had ventricular tachycardia induced at electrophysiologic study and metoprolol never prevented induction. Sympathetic denervation was also detected in two of seven postinfarction patients without ventricular arrhythmias. Normal control subjects had no regions lacking MIBG uptake.
This study provides evidence that regional sympathetic denervation occurs in humans after myocardial infarction and can be detected noninvasively by comparing MIBG and thallium-201 images. Although the presence of sympathetic denervation may be related to the onset of spontaneous ventricular tachyarrhythmias in some patients, it does not appear to be related to sustained ventricular tachycardia induced at electrophysiologic study.