Prognostic Significance of Neuroadrenergic Dysfunction for Cardiovascular Events in Patients With Acute Myocardial Infarction

Masatoshi Minamisawa; Atsushi Izawa; Hirohiko Motoki; Yuichiro Kashima; Hirofumi Hioki; Naoyuki Abe; Takashi Miura; Soichiro Ebisawa; Yusuke Miyashita; Jun Koyama; Uichi Ikeda

doi:10.1253/circj.CJ-15-0265

Ischemic Heart Disease

Prognostic Significance of Neuroadrenergic Dysfunction for Cardiovascular Events in Patients With Acute Myocardial Infarction

Masatoshi Minamisawa, Atsushi Izawa, Hirohiko Motoki, Yuichiro Kashima, Hirofumi Hioki, Naoyuki Abe, Takashi Miura, Soichiro Ebisawa, Yusuke Miyashita, Jun Koyama, Uichi Ikeda

Author information

Masatoshi Minamisawa
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Atsushi Izawa
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Hirohiko Motoki
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Yuichiro Kashima
Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine
Hirofumi Hioki
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Naoyuki Abe
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Takashi Miura
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Soichiro Ebisawa
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Yusuke Miyashita
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Jun Koyama
Department of Cardiovascular Medicine, Shinshu University School of Medicine
Uichi Ikeda
Department of Cardiovascular Medicine, Shinshu University School of Medicine

Keywords: Acute myocardial infarction, Autonomic nervous system, Blood pressure, Cardiovascular events

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2015 Volume 79 Issue 10 Pages 2238-2245

DOI https://doi.org/10.1253/circj.CJ-15-0265

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Abstract

Background:The dysregulation of systemic blood pressure (BP) variation or cardiac neuroadrenergic dysfunction is associated with adverse cardiovascular events. We aimed to clarify the prognostic significance of neuroadrenergic dysfunction for cardiovascular events in patients with acute myocardial infarction (AMI).Methods and Results:We enrolled 63 AMI patients (mean age, 67±12 years) underwent ambulatory BP monitoring (ABPM) and cardiac iodine-¹²³metaiodobenzylguanidine (MIBG) imaging within 4 weeks after AMI onset. We analyzed the circadian BP pattern and heart-to-mediastinum (H/M) MIBG uptake ratio. All the patients were followed for 2 years. The study endpoint was a composite of major adverse cardiovascular events, including all-cause death, MI, coronary revascularization except for the MI culprit lesion, and stroke. Patients with a non-dipper pattern (n=29) or an H/M ratio <1.96 (n=28) had a worse prognosis than those with either a dipper pattern (n=34) or an H/M ratio ≥1.96 (n=35; log-rank, P=0.013 and 0.010, respectively). Patients with both a non-dipper pattern and an H/M ratio <1.96 (n=12) had a significantly worse prognosis than did the other patients (P=0.0020).Conclusions:Dysregulation of BP variation and cardiac MIBG uptake were associated with cardiovascular events following AMI. Examining ABPM with MIBG imaging may potentially improve risk stratification in these patients. (Circ J 2015; 79: 2238–2245)

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