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22.07.2017 | Original Article | Ausgabe 13/2017

European Journal of Nuclear Medicine and Molecular Imaging 13/2017

Cardiac sympathetic neuronal damage precedes myocardial fibrosis in patients with Anderson-Fabry disease

Zeitschrift:
European Journal of Nuclear Medicine and Molecular Imaging > Ausgabe 13/2017
Autoren:
Massimo Imbriaco, Teresa Pellegrino, Valentina Piscopo, Mario Petretta, Andrea Ponsiglione, Carmela Nappi, Marta Puglia, Serena Dell’Aversana, Eleonora Riccio, Letizia Spinelli, Antonio Pisani, Alberto Cuocolo

Abstract

Purpose

Cardiac sympathetic denervation may be detectable in patients with Anderson-Fabry disease (AFD), suggesting its usefulness for early detection of the disease. However, the relationship between sympathetic neuronal damage measured by 123I–metaiodobenzylguanidine (MIBG) imaging with myocardial fibrosis on cardiac magnetic resonance (CMR) is still unclear.

Methods

Cardiac sympathetic innervation was assessed by 123I–MIBG single-photon emission computed tomography (SPECT) in 25 patients with genetically proved AFD. Within one month from MIBG imaging, all patients underwent contrast-enhanced CMR. MIBG defect size and fibrosis size on CMR were measured for the left ventricle (LV) and expressed as %LV.

Results

Patients were divided into three groups according to MIBG and CMR findings: (1) matched normal, without MIBG defects and without fibrosis on CMR (n = 10); (2) unmatched, with MIBG defect but without fibrosis (n = 5); and (3) matched abnormal, with MIBG defect and fibrosis (n = 10). The three groups did not differ with respect to age, gender, α-galactosidase, proteinuria, glomerular filtration rate, and troponin I, while New York Heart Association class (p = 0.008), LV hypertrophy (p = 0.05), and enzyme replacement therapy (p = 0.02) were different among groups. Although in patients with matched abnormal findings, there was a significant correlation between MIBG defect size and area of fibrosis at CMR (r2 = 0.98, p < 0.001), MIBG defect size was larger than fibrosis size (26 ± 23 vs. 18 ± 13%LV, p = 0.02).

Conclusion

Sympathetic neuronal damage is frequent in AFD patients, and it may precede myocardial damage, such as fibrosis. Thus, 123I–MIBG imaging can be considered a challenging technique for early detection of cardiac involvement in AFD.

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