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Tesi etd-12092019-115208


Tipo di tesi
Tesi di dottorato di ricerca
Autore
LIGA, RICCARDO
URN
etd-12092019-115208
Titolo
The Interaction between Cardiac Sympathetic Tone and Left Ventricular Hypertrophy in Patients with Severe Aortic Stenosis undergoing Trans-catheter Aortic valve Implantation
Settore scientifico disciplinare
MED/11
Corso di studi
FISIOPATOLOGIA CLINICA
Relatori
tutor Prof.ssa Petronio, Anna Sonia
Parole chiave
  • 123I-MIBG
  • Aortic stenosis
  • Cardiac innervation
  • Cardiac SPECT
  • Left ventricular hypertrophy
Data inizio appello
25/12/2019
Consultabilità
Non consultabile
Data di rilascio
25/12/2059
Riassunto
Aims: To assess cardiac innervation on 123I-metaiodobenzylguanidine (MIBG) imaging in patients with left ventricular hypertrophy (LVH) and aortic stenosis (AS) submitted to transcatheter aortic valve implantation (TAVI) as compared to matched uncomplicated hypertensive patients.
Methods: Twenty-two elder (82±5 years) patients with severe AS and severe LVH were recruited. Fourteen matched HT patients with similar degree of LVH and 10 healthy subjects were used as controls. MIBG and 99mTc-tetrofosmin single-photon emission computed-tomography (SPECT) acquisition were obtained to assess sympathetic innervation and LV perfusion. The innervation/perfusion mismatch score was computed, as an indicator of cardiac risk. In TAVI patients the imaging protocol was repeated 6 months after the procedure.
Results: Regional MIBG uptake was significantly more inhomogeneous in HT and AS than controls and, therefore, innervation/perfusion mismatch score was higher in both AS (9±8) and HT (5±2) patients than controls (1±1, P<0.001). On multivariate analysis, the presence of severe LVH was an independent predictors of impaired LV sympathetic innervation [OR: 19.45, 95%CI (1.87-201.92); P=0.013]. In patients undergoing TAVI, no differences in measures of LV sympathetic innervation were observed 6 months after the procedure with only a marginal LV mass reduction (-5.4±2.4 g).
Conclusions: Cardiac sympathetic innervation is significantly impaired in elder patients with LVH, either with AS or not.
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