Derk O Verschure1, Joris R de Groot2, Siroos Mirzaei3, Olivier Gheysens4, Kenichi Nakajima5, Berthe L F van Eck-Smit6, G Aernout Somsen7, Hein J Verberne6. 1. Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Zaans Medical Center, Zaandam, The Netherlands. Electronic address: d.o.verschure@amc.uva.nl. 2. Heart Center, Department of Cardiology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 3. Department of Nuclear Medicine, Wilhelminenspital, Vienna, Austria. 4. Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium. 5. Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan. 6. Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 7. Cardiology Centers of the Netherlands, Amsterdam, The Netherlands.
Abstract
AIM: Chronic heart failure (CHF) is a life-threatening clinical syndrome, partly due to sudden cardiac death (SCD). Implantable cardioverter defibrillators (ICD) for primary prevention of SCD have improved overall survival of CHF patients. However, a high percentage of patients never receives appropriate ICD therapy. This prospective multicentre study evaluated whether cardiac sympathetic activity assessed by 123I-mIBG scintigraphy could be helpful in selecting patients for ICD implantation. MATERIALS AND METHODS: 135 stable CHF subjects (age 64.5±9.3years, 79% male, LVEF 25±6%) referred for prophylactic ICD implantation were enrolled in 13 institutions. All subjects underwent planar and SPECT 123I-mIBG scintigraphy. Early and late heart-to-mediastinum (H/M) ratio, 123I-mIBG washout (WO) and late summed scores were calculated. The primary endpoint was appropriate ICD therapy. The secondary endpoint was defined as the combined endpoint of all first cardiac events: appropriate ICD therapy, progression of heart failure (HF) and cardiac death. RESULTS: During a median follow-up of 30months (6-68months), 24 subjects (17.8%) experienced a first cardiac event (appropriate ICD therapy [12], HF progression [6], cardiac death [6]). Late H/M ratio and defect size of 123I-mIBG SPECT were not associated with appropriate ICD therapy. However, late H/M ratio was independently associated with the combined endpoint (HR 0.135 [0.035-0.517], p=0.001). Post-hoc analysis showed that the combination of late H/M ratio (HR 0.461 [0.281-0.757]) and LVEF (HR 1.052 [1.021-1.084]) was significantly associated with freedom of appropriate ICD therapy (p<0.001). CONCLUSION: 123I-mIBG scintigraphy seems to be helpful in selecting CHF subjects who might not benefit from ICD implantation.
AIM: Chronic heart failure (CHF) is a life-threatening clinical syndrome, partly due to sudden cardiac death (SCD). Implantable cardioverter defibrillators (ICD) for primary prevention of SCD have improved overall survival of CHFpatients. However, a high percentage of patients never receives appropriate ICD therapy. This prospective multicentre study evaluated whether cardiac sympathetic activity assessed by 123I-mIBG scintigraphy could be helpful in selecting patients for ICD implantation. MATERIALS AND METHODS: 135 stable CHF subjects (age 64.5±9.3years, 79% male, LVEF 25±6%) referred for prophylactic ICD implantation were enrolled in 13 institutions. All subjects underwent planar and SPECT 123I-mIBG scintigraphy. Early and late heart-to-mediastinum (H/M) ratio, 123I-mIBG washout (WO) and late summed scores were calculated. The primary endpoint was appropriate ICD therapy. The secondary endpoint was defined as the combined endpoint of all first cardiac events: appropriate ICD therapy, progression of heart failure (HF) and cardiac death. RESULTS: During a median follow-up of 30months (6-68months), 24 subjects (17.8%) experienced a first cardiac event (appropriate ICD therapy [12], HF progression [6], cardiac death [6]). Late H/M ratio and defect size of 123I-mIBG SPECT were not associated with appropriate ICD therapy. However, late H/M ratio was independently associated with the combined endpoint (HR 0.135 [0.035-0.517], p=0.001). Post-hoc analysis showed that the combination of late H/M ratio (HR 0.461 [0.281-0.757]) and LVEF (HR 1.052 [1.021-1.084]) was significantly associated with freedom of appropriate ICD therapy (p<0.001). CONCLUSION:123I-mIBG scintigraphy seems to be helpful in selecting CHF subjects who might not benefit from ICD implantation.
Authors: Luiz Eduardo Mastrocola; Barbara Juarez Amorim; João Vicente Vitola; Simone Cristina Soares Brandão; Gabriel Blacher Grossman; Ronaldo de Souza Leão Lima; Rafael Willain Lopes; William Azem Chalela; Lara Cristiane Terra Ferreira Carreira; José Roberto Nolasco de Araújo; Cláudio Tinoco Mesquita; José Claudio Meneghetti Journal: Arq Bras Cardiol Date: 2020-02 Impact factor: 2.000
Authors: Jason G E Zelt; Jean Zhuo Wang; Lisa M Mielniczuk; Rob S B Beanlands; James A Fallavollita; John M Canty; Robert A deKemp Journal: Circ Cardiovasc Imaging Date: 2021-06-09 Impact factor: 8.589
Authors: Rudolf A Werner; Xinyu Chen; Mitsuru Hirano; Steven P Rowe; Constantin Lapa; Mehrbod S Javadi; Takahiro Higuchi Journal: Clin Transl Imaging Date: 2018-07-03