Scintigraphic assessment of cardiac sympathetic innervation and myocardial perfusion in patients with atrial fibrillation

The objective of this study was to examine cardiac innervation and myocardial perfusion in patients with atrial fibrillation (AF). Methods. The study included 40 patients with coronary artery disease (CAD), hypertension 3 class. There were 3 groups of patients: 15 with paroxysmal AF (PAF), 15 with long-standing persistent AF (LSPAF) and 10 patients with sinus rhythm (SR). All patients underwent scintigraphy with¹²³I-MIBG to evaluate of cardiac sympathetic activity. Heart-to-mediastinum (H/M) ratios and the washout rate (WR) were calculated from planar imaging. From SPECT images, the¹²³I-MIBG SPECT defect score was calculated by assessment of patient’s segmental¹²³I-MIBG tracer uptake score using the 17-segment model. Also all patients underwent SPECT with^99mTc-MIBI to evaluate of myocardial perfusion. Results. In patients with PAF and LSPAF the early H/M ratio and delayed H/M ratio was significantly lower compared to control subjects (early planar images: 1,57 ± 0,15 vs. 1,54 ± 0,18 vs. 1,82 ± 0,12, respectively; P < 0,05; delayed planar images: 1,47 ± 0,15 vs. 1,46 ± 0,16 vs. 1,83 ± 0,13, respectively; P < 0,05). The washout rate of¹²³I-MIBG in both the patients with PAF and LSPAF was greater compared to patients with SR (31,2 % ± 11,5 % vs. 29,4 % ± 10,5 % vs. 17,5 % ± 10,3 %, respectively; P < 0,05). However, both early and delayed SPECT images showed that the sympathetic activity defect was significantly larger in patients with LSPAF compared to patients with PAF and patients with SR (P < 0.05). No statistically significant differences were found between groups in perfusion defect score. Conclusion. Our study showed that more sympathetic innervation abnormality was observed in patients with AF in relation to the group of patients with SR. The AF has no significant effect on myocardial perfusion, and the most significant violation of the regional sympathetic activity observed in patients with LSPAF.

фибрилляция предсердий, однофотонная эмиссионная компьютерная томография, ¹²³I-МИБГ , симпатическая иннервация, ^99mТс-МИБИ , atrial fibrillation, single-photon emission computed tomography, ¹²³I-MIBG , sympathetic innervation, ^99mTc-MIBI

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