ASSESSMENT OF PERFUSION AND METABOLISM OF MYOCARDIUM IN NONCORONAROGENIC VENTRICULAR ARRHYTHMIA

Objective. To analyze myocardial blood low and metabolism in patients with high gradation nonischemic ventricular arrhythmia (VA).

Design and methods. Sixteen patients (9 males, 7 females, average age — 44 ± 99м 6,5 years) were enrolled. One-photon emission computer tomography with Tc-tetraphosmine at rest and at the physical training (veloergometry) were performed for myocardial perfusion examination. Estimation of fatty acids metabolism in myocardium was performed by positron-emission tomography (PET) with С-natrium butyrate. Control groups included age- and sex-matched 10 patients with coronary artery disease (CAD) and VA and 10 99м healthy volunteers.

Results. At rest diffused equal distribution of Tc-tetraphosmine was revealed in 93,75 % patients. Reversible diffused stress-induced defects were found at exercise training test, but the changes were not signiicant. There were no changes in myocardial metabolism and no changes in the rate of fatty acids metabolism. Thus, diffused changes of metabolism and perfusion of left ventricle were found in the most patients with VA. Whereas there were no changes in healthy volunteers, and we found reduced extraction and velocity of fatty acids utilization in areas of left ventricle with stress-induced changes of perfusion in the group with CAD and VA.

 Conclusions. PET is an effective method to conirm nonischemic character of VA, and in most cases of VA it is helpful to ind diffused changes of metabolism and perfusion of left ventricle. These might be important when a treatment approach is to be chosen.

1. Wever E.F., Robles de Medina E.O. Sudden death in patients without structural heart disease // J. Am. Coll. Cardiol. — 2004. — Vol. 43, № 7. — P. 1137–1144.

2. Martinez R.U., Lizalde C.L., Guevara-Valdivia M.E. et al. Ventricular tachycardia associated with isolated right ventricular dysfunction as indicator of arrhythmogenic dysplasia of the right ventricle // Arch. Cardiol. Mex. — 2001. — Vol. 71, № 4. — P. 324–329.

3. Nemes A., Vletter W.B., Scholten M.F., ten Cate F.G. Contrast echocardiography for perfusion in right ventricular cardiomyopathy // Eur. J. Echocardiogr. — 2005. — Vol. 6, № 6. — P. 470–472.

4. Ozava T. Mitochondrial cardiomyopathy // Herz. — 1994. — Vol. 19, № 2. — P. 105–118.

5. Marin-Garcia J., Goldenthal M.J. Cardiomyopathy and abnormal mitochondrial function // Cardiovasc. Res. — 1994. — Vol. 28, № 4. — P. 456–463.

6. Zipes D.P., Camm A.J., Borggrefe M. et al. European Heart Rhythm Association; Heart Rhythm Society, American College of Cardiology; American Heart Association Task Force; European Society of Cardiology Committee for Practice Guidelines. ACC/AHA/ESC 2006 Guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death // J. Am. Coll. Cardiol. — 2006. — Vol. 48, № 5. — P. 247–346.

7. Marin-Garcia J., Goldenthal M.J., Gordon G.W. Moe Abnormal cardiac and skeletal muscle mitochondrial function in pacing-induced cardiac failure // Cardiovasc. Res. — 2001. — Vol. 52, № 1. — P. 103–110.

8. Guertl B., Noehammer C., Hoefler G. Metabolic cardiomyopathies // Int. J. Exp. Patrol. — 2000. — Vol. 81, № 6. — Р. 349–372.9. Feuvray D. Arrhythmia and metabolism // Heart Metab. — 2006. — Vol. 33. — [Electronic resource]. — URL: http://www.heartandmetabolism.org/issues/HM33/HM33editorial.asp

9. Pieroni M., Chimenti C., De Cobelli F. et al. Fabry’s disease cardiomyopathy: echocardiographic detection of endomyocardial glycosphyngolipid compartmentalization // J. Am. Coll. Cardiol. — 2006. — Vol. 47, № 8. — P. 1663–1671.

10. Zingman L.V., Alekseev A.E., Hodgson-Zingman D.M., Terzic A. ATP-sensitive potassium channels: metabolic sensing and cardioprotection // J. Appl. Physiol. — 2007. — Vol. 103, № 5. — P. 1888–1893.

11. Ruf K., Hebestreit H. Exercise-induced hypoxemia and cardiac arrhythmia in cystic ibrosis // J. Cyst. Fibros. — 2009. — Vol. 8, № 2. — P. 83–90.

12. Cunningham K.S., Veinot J.P., Butany J. An approach to endomyocardial biopsy interpretation // J. Clin. Pathology. — 2006. — Vol. 59, № 2. — P. 121–129.

13. Yamamoto S., James T.N., Kawamura K., Nobuyoshi M. Cardiocytic apoptosis and cappilary endothelian swelling as morphological evidence of myocardial ischemia in ventricular biopsies from patients with angina and normal arteriograms // Coron. Artery Dis. — 2002. — Vol. 13, № 1. — P. 25–35.

14. Cohn J.N. Arteries, myocardium, blood pressure and cardiovascular risk: towards a revised deinition of hypertension //J. Hypertens. — 1998. — Vol. 16, № 12, Pt. 2. — P. 2117–2124.

15. Savopoulos C., Ziakas A., Hatzitolios A., Delivoria C., Kounanis A., Mylonas S. et al. Cardiac rhythm in sudden cardiac death: a retrospective study of 2665 cases // Angiology. — 2006. — Vol. 57, № 2. — P. 197–204.

16. Veinot J.P., Johnston B., Acharya V., Healey J. The spectrum of intramyocardial small vessel disease associated with sudden death // J. Forensic Sci. — 2002. — Vol. 47, № 2. — P. 384–388.

17. Hurwitz G.A., Blais M., Powe J.E., Champagne C.L. Stress/injection protocols for myocardial scintigraphy with 99Tcm-sestamibi compared with 201T1: implications of early post-stress kinetics // Nucl. Med. Commun. — 1996. — Vol. 17, № 5. — P. 400–409.

18. Klocke F.J., Baird M.G., Lorell B.H., et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging- executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging)// J. Am. Coll. Cardiol. — 2003. — Vol. 1, № 42. — P. 1318–1333.

19. Janousek S., Janda I., Simek P., Rotrekl P., Horak Z. Thallium perfusion scintigraphy and bicycle ergometry in the diagnosis of ischemic heart disease. Comparison with coronarography indings // Vnitr Lek. — 1997. — Vol. 43, № 12. — P. 790–794.

20. Britten J.S., Blank M. Thallium activation of the Na-K-ATPase of rabbit kidney // Biochim. Biophys. Acta. — 1968. — Vol. 159, № 1. — P. 160–169.

21. Weich H.F., Strauss H.W., Pitt В. The extraction of thallium-201 by the myocardium // Circulation. — 1977. — Vol. 56, № 2. — P. 188–191.

22. Самойленко Л.Е., Спижовый В.Н., Лякишев А.А. Значение cцинтиграфии миокарда с 201Tl в диагностике ишемической болезни сердца // Кардиология. — 1988. — № 11. — С. 71–74. / Samoilenko L.E., Spyzhoviy V.N., Lyakishev A.A. Myocardium 201T1-scintigraphy in the diagnosis of coronary artery disease // Cardiology [Kardiologiia]. — 1988. — № 11. — P. 71–74 [Russian].

23. Caldwell J.H., Martin G.V., Link J.M., Krohn K.A., Bassingthwaighte J.B. Iodophenylpentadecanoic acidmyocardial blood low relationship during maximal exercise with соronaгу occlusion // J. Nucl. Med. — 1990. — Vol. 31, № 1. — P. 99–

24. Tamaki N., Kawamoto M., Yonekura Y. et al. Assessment of fatty acid metabolism using 1–123 branched fatty acid: comparison with positron emission tomography // Ann. Nucl. Med. — 1993. — № 7. — P. 41–48.

25. Schelbert H. Different roads to the assessment of myocardial viability lessons from PET for SPECT // Circulation. — 1995. — Vol. 91, № 6. — P. 1894–1895.

26. Froelicher V.F., Lehmann K.G., Thomas R., Goldman S., Morrison D., Edson R., Lavori P., Myers J., Dennis C., Shabetai R., Do D., Froning J. The electrocardiographic exercise test in a population with reduced workup bias: diagnostic performance, computerized interpretation, and multivariable prediction. Veterans Affairs Cooperative Study in Health Services #016 (QUEXTA) Study Group. Quantitative Exercise Testing and Angiography // Ann. Intern. Med. — 1998. — Vol. 128, № 12, Pt. 1. — P. 965–974.

27. Рыжкова Д.В. Применение позитронной эмиссионной томографии миокарда с С-бутиратом натрия для диагностики ишемической болезни сердца и определения жизнеспособно-сти дисфункционирующего миокарда: Автореф. дис. ... канд. мед. наук. — СПБ., 2002. — 21 с. / Ryzhkova D.V. Myocardium positron emission tomography with 11C-natrium butyrate for the diagnosis of coronary artery disease and assessment of the myocardial vitability: PhD thesis. — St Petersburg, 2002. — 21 p. [Russian].

28. Schweikert R.A., Pashkow F.J., Snader C.E., Marwick T.H., Lauer M.S. Association of exercise-induced ventricular ectopic activity with thallium myocardial perfusion and angiographic coronary artery disease in stable, low-risk populations // Am. J. Cardiol. — 1999. — Vol. 83, № 4. — P. 530–534.

29. Matsumoto K., Takahashi N., Ishikawa T., Sumita S., Matsushita K., Inoue N. et al. Evaluation of myocardial glucose metabolism before and after recovery of myocardial function in patients with tachycardia-induced cardiomyopathy // Pacing Clin. Electrophysiol. — 2006. — Vol. 29, № 2. — P. 175–180.

30. Иванов Г.Г., Агеева И.В., Бабаахмади С., Хасан С.Н. Структурное и электрофизиологическое ремоделирование миокарда: определение понятия и применение в клинической практике // Функциональная диагностика. — 2003. — № 1. —

31. С. 101–109. / Ivanov G.G., Ageeva I.V., Babaakhmadi S., Khasan S.N. Structural and electrical remodeling of the myocardium: deinitions and clinical application // Functional diagnostics [Funktsionalnaya Diagnostika]. — 2003. — № 1. — Р. 101–109 [Russian].

32. Розенберг В.Д., Непомнящих Л.М. Патоморфология сосудистого русла при разных вариантах развития аритмогенного сердца // Бюлл. эксперим. биологии и медицины. — 2004. — Т. 137, № 2. — С. 225–230. / Rosenberg V.D., Nepomnyashchikh L.M. Pathomorphology of the vascular bed in different arrhythmogenic pathologies. — 2004. — Vol. 137, № 2. — P. 225–230 [Russian].

33. Рыжкова Д.В. Позитронная эмиссионная томография в комплексной диагностики ишемической болезни сердца: Автореф. дис. ...д-ра мед. наук. Рос. науч. центр радиол. хирург. технол. — Томск, 2008. — 45 с. / Ryzhkova D.V. Positron emission tomography in complex diagnostics of coronary artery disease: Doctoral PhD thesis. — Tomsk, 2008. — 45 p. [Russian].

34. Schwenk R.W., Luiken J.J., Bonen A., Glatz J.F. Regulation of sarcolemmal glucose and fatty acid transporters in cardiac disease // Cardiovasc. Res. — 2008. — Vol. 79, № 2. — P. 249–258.

35. Бернгардт Э.Р., Пармон Е.В., Трешкур Т.В., Шляхто Е.В. Тахииндуцированная кардиомиопатия: клини-копатогенетические аспекты // Артериальная гипертензия. — 2008. — Т. 14, № 1. — С. 48–53. / Berngardt E.R., Parmon E.V., Treshkur T.V., Shlyakhto E.V. Tachycardia-induced cardiomyopathy: clinical and pathomorphological issues // Arterial Hypertension [Arterialnaya Gipertenziya]. — 2008. — Vol. 14, № 1. — Р. 48–53 [Russian].

36. Пармон Е.В., Трешкур Т.В., Шляхто Е.В. Идиопатические желудочковые нарушения ритма (анализ проблемы) // Вестник аритмологии. — 2003. — № 32. — С. 60–71. / Parmon E.V., Treshkur T.V., Shlyakhto E.V. Idiopathic heart rhythm disturbances (analysis of the problem) // Bulletin of the Arrhythmology [Vestnik Aritmologii]. — 2003. — № 32. — Р. 60–71 [Russian].

37. Пармон Е.В. Особенности аритмогенной дисплазии правого желудочка // Бюлл. ФЦСКЭ им. В.А. Алмазова. — 2011. — Т. 4, № 9. — С. 5–14. / Parmon E.V. Features of the arrhythmogenic right ventricular dysplasia // Bulletin of the Almazov Centre [Bulleten FCSKE im. V.A. Almazova] . — 2011. — Vol. 4, № 9. — Р. 5–14 [Russian].

38. Horimoto M., Akino M., Takenata M., Igarashi K., Inoue H., Kawakami Y. Evolution of left ventricular involvment in arrhythmogenic right ventricular cardiomyopathy // Cardiology. — 2000. — Vol. 93, № 3. — P. 197–200.