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Cardiac sympathetic nervous disintegrity is related to exercise intolerance in patients with chronic heart failure

SUMMARYThe aim of this study was to clarify the relationship between cardiac sympathetic nervous activity assessed by 123I-MIBG imaging and exercise capacity in patients with congestive heart failure. The subjects were 24 patients with heart failure (NYHA class II to III) and 7 normal controls. A dose of 148 MBq of 123I-MIBG was administered intravenously, and 5-min anterior planar images were obtained 20 min (early) and 4 h (delayed) after the injection of 123I-MIBG. Regions of interest were placed over the left ventricle and mediastinum, and the heart-to-mediastinum ratio (H/M ratio) was calculated as a fraction of the mean counts per pixel in the heart divided by those in the mediastinum. The washout rate from the myocardium was determined by: (early counts — delayed counts) X 100/early counts (%). Treadmill exercise tests were performed using a ramp method within 1 week of the 123I-MIBG studies. During exercise, expired gas was analysed, and peak VO2 and VO2 at the anaerobic threshold (AT VO2) were measured. A significant linear correlation was found between the H/M ratio on delayed 123I-MIBG images and exercise duration (r = 0.48, P < 0.05), peak VO2 (r = 0.49, P < 0.05) and AT VO2 (r = 0.56, P <0.01). The washout rate of 123I-MIBG was inversely correlated with exercise duration (r = - 0.45, P <0.05), peak VO2 (r = - 0.51, P <0.01), and AT VO2 (r = - 0.50, P <0.05). In conclusion, enhanced cardiac sympathetic nervous activity relates to exercise intolerance in patients with congestive heart failure. The non-invasive assessment of cardiac sympathetic nervous activity by 123I-MIBG can predict exercise capacity in human heart failure.