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07. Syncope and Bradycardia
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Relationship of left ventricular global longitudinal strain with cardiac autonomic denervation as assessed by 123I-mIBG scintigraphy in patients with heart failure with reduced ejection fraction submitted to cardiac resynchronization therapy
Session:
CO 10 - Insuficiência Cardíaca
Speaker:
Madalena Coutinho Cruz
Congress:
CPC 2018
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.3 Chronic Heart Failure – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Madalena Coutinho Cruz; Ana Abreu; Guilherme Portugal; Helena Santa-Clara; Pedro Silva Cunha; Mário Martins Oliveira; Vanessa Santos; Luís Oliveira; Pedro Rio; Dra. Inês Rodrigues; Luís Almeida Morais; Rui Cruz Ferreira; Miguel Mota Carmo
Abstract
<p><strong>Introduction:</strong> Heart failure (HF) is associated with dampened cardiovascular reflexes and downregulation of adrenergic nerve terminals in the myocardium. Non-invasive assessment of cardiac denervation by <sup>123</sup>I-metaiodobenzylguanidine (<sup>123</sup>I-mIBG) scintigraphy allows for prediction of arrhythmic events and response to cardiac resynchronization therapy (CRT) in advanced HF patients. However, <sup>123</sup>I-mIBG scintigraphy is not readily accessible and requires exposure to radiation. We hypothesized that myocardial contractility would reflect local autonomic denervation and as such, would allow for estimation of cardiac autonomic dysfunction. Our aim was to study the relationship between myocardial contractility as assessed by global longitudinal strain (GLS) and autonomic dysfunction as assessed by <sup>123</sup>I-mIBG scintigraphy in advanced HF patients.</p> <p><strong>Methods:</strong> BETTER-HF is a prospective study which included patients with HF with reduced ejection fraction (HFrEF) submitted to CRT. Patients were submitted to a baseline (before CRT) clinical, echocardiographic and scintigraphic assessment, which was repeated at 6 months after CRT. Echocardiographic response was defined as an absolute increase in left ventricular ejection fraction (LVEF) ≥ 10%. Cardiac denervation was defined as a late heart-to-mediastinum ratio (HMR) < 1.6. The association between GLS and autonomic denervation at baseline and 6 months was explored with the Pearson’s correlation coefficient and receiver operating curve (ROC) analysis.</p> <p><strong>Results:</strong> 81 patients (mean age 68.1 ± 12.9 years, 67.5% males, 28.8% ischemic cardiomyopathy, 72.5% NYHA class III-IV, LVEF 26.3% ± 7.1%, brain natriuretic peptide 574.8 ± 604.5 pg/mL) were included. An echocardiographic response was observed in 73.7% of patients at 6 months. There was a significant improvement during the study period regarding LVEF, left ventricular endsystolic volume, mean E/e' ratio, and GLS (p < 0.05 for all), but no significant difference regarding cardiac denervation. A higher late HMR at baseline was associated with a better echocardiographic response to CRT (OR 11.6 95% CI 1.17-114.00 p=0.036). This result was independent of LVEF. There was a significant association between late HMR and GLS, both at baseline (p=0.010) and at 6 months (p=0.021). For the baseline assessment, GLS had an area under the ROC of 0.715 for discrimination of a late HMR < 1.6 (Figure). A GLS cutoff of - 9% maximized the likelihood of correctly classifying a patient as having severe cardiac denervation (likelihood ratio 2.83).</p> <p><strong>Conclusion:</strong> Myocardial contractility assessed by GLS is associated with cardiac denervation as assessed by <sup>123</sup>I-mIBG scintigraphy and has a good discrimination for the identification of severe autonomic dysfunction. GLS may allow for a more readily accessible estimation of the degree of cardiac denervation in advanced HF.</p>
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