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J Thorac Cardiovasc Surg 2004;127:517-524
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Cardiac denervation after clinical transmyocardial laser revascularization: Short-term and long-term iodine 123–labeled meta-iodobenzylguanide scintigraphic evidence

^a Laser Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
^b Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
^c Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
^d Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
^e Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Received for publication September 30, 2002; revisions received January 21, 2003; accepted for publication April 14, 2003.

^* Address for reprints: Johan F. Beek, MD, PhD, Laser Center, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100DE, Amsterdam, The Netherlands
j.f.beek{at}amc.uva.nl

OBJECTIVES: This study was designed to investigate whether transmyocardial laser revascularization induces myocardial denervation and to correlate this with myocardial perfusion and clinical status.

METHODS: Transmyocardial laser revascularization was performed with a Holmium:YAG (n = 3) or xenon chloride excimer laser (n = 5). Preoperative and postoperative iodine 123–labeled meta-iodobenzylguanide SPECT scintigraphy to assess cardiac innervation and perfusion scintigraphy were also performed. Furthermore, New York Heart Association functional angina class and quality of life were assessed.

RESULTS: In all patients postoperative iodine 123–labeled meta-iodobenzylguanide SPECT showed significantly decreased uptake and therefore sympathetic myocardial denervation at up to 16 months' follow-up (average preoperative and postoperative summed defect scores of 14.8 ± 5.3 and 24.5 ± 4.2, respectively; P = .00005). In 86% of segments, the decreased meta-iodobenzylguanide uptake could be correlated to the treated area. In all patients angina was reduced by 2 or more classes at 12 months' follow-up, and quality of life improved significantly.

CONCLUSIONS: Transmyocardial laser revascularization–induced improvement of angina and quality of life can be explained by destruction of nociceptors or cardiac neural pathways, changing the perception of anginal pain.

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