Rita Ilhão Moreira1, Ana Abreu2, Guilherme Portugal2, Luís Oliveira3, Mário Oliveira2, Inês Rodrigues2, Madalena Coutinho Cruz2, Pedro Silva Cunha2, Vanessa Santos4, Helena Santa Clara4, Miguel Mota Carmo2,5, Rui Cruz Ferreira2. 1. Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, 1169-024, Lisbon, Portugal. ritailhaomoreira@gmail.com. 2. Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, 1169-024, Lisbon, Portugal. 3. Nuclear Medicine Department, Medical and Diagnosis Clinic Quadrantes, Lisbon, Portugal. 4. CIPER, Human Kinetics Faculty, University of Lisbon, Lisbon, Portugal. 5. NOVA Medical School, New University of Lisbon, Lisbon, Portugal.
Abstract
BACKGROUND:Cardiac autonomic dysfunction as assessed by 123I-metaiodobenzylguanidine (123I-mIBG) scintigraphy is associated with poor prognosis in heart failure (HF) patients. Although cardiac resynchronization therapy (CRT) has emerged as an effective therapy in improving outcomes on HF patients, its effect on cardiac sympathetic nervous function is still not fully understood. We aimed to study the value of pre-implantation 123I-mIBG late heart-to-mediastinum ratio (HMR) as a predictor of response and outcomes after CRT and to correlate modification in this parameter with CRT response and functional improvement. METHODS AND RESULTS: BETTER-HF (Benefit of exercise training therapy and cardiac resynchronization in HF patients) is a prospective randomized clinical trial including HF patients submitted CRT (mean LVEF 24 ± 8%, 74% NYHA class ≥ III) who underwent a clinical, echocardiographic, and scintigraphic assessment before and 6 months after CRT. One-hundred and twenty-one patients were included. Echocardiographic response was observed in 54% and composite outcome of cardiac mortality, cardiac transplant or heart failure hospitalization in 24% of patients. Baseline late HMR was an independent predictor of CRT response (regression coefficient 2.906, 95% CI 0.293-3.903, P .029) and outcomes (HR 0.066 95% CI 0.005-0.880, P .040). At follow-up, 123I-mIBG imaging showed positive changes in cardiac sympathetic nerve activity only in responders to CRT (1.36 ± 0.14 prior vs. 1.42 ± 0.16 after CRT, P .039). There was a significant correlation between improvement in late HMR and improvement in peak oxygen consumption (r 0.547, P < .001). CONCLUSION: In our study, baseline cardiac denervation predicted response and clinical outcomes after CRT implantation. Cardiac sympathetic function was improved only in patients who responded to CRT and these positive changes were correlated with improvement in functional capacity.
RCT Entities:
BACKGROUND:Cardiac autonomic dysfunction as assessed by 123I-metaiodobenzylguanidine (123I-mIBG) scintigraphy is associated with poor prognosis in heart failure (HF) patients. Although cardiac resynchronization therapy (CRT) has emerged as an effective therapy in improving outcomes on HF patients, its effect on cardiac sympathetic nervous function is still not fully understood. We aimed to study the value of pre-implantation 123I-mIBG late heart-to-mediastinum ratio (HMR) as a predictor of response and outcomes after CRT and to correlate modification in this parameter with CRT response and functional improvement. METHODS AND RESULTS: BETTER-HF (Benefit of exercise training therapy and cardiac resynchronization in HF patients) is a prospective randomized clinical trial including HF patients submitted CRT (mean LVEF 24 ± 8%, 74% NYHA class ≥ III) who underwent a clinical, echocardiographic, and scintigraphic assessment before and 6 months after CRT. One-hundred and twenty-one patients were included. Echocardiographic response was observed in 54% and composite outcome of cardiac mortality, cardiac transplant or heart failure hospitalization in 24% of patients. Baseline late HMR was an independent predictor of CRT response (regression coefficient 2.906, 95% CI 0.293-3.903, P .029) and outcomes (HR 0.066 95% CI 0.005-0.880, P .040). At follow-up, 123I-mIBG imaging showed positive changes in cardiac sympathetic nerve activity only in responders to CRT (1.36 ± 0.14 prior vs. 1.42 ± 0.16 after CRT, P .039). There was a significant correlation between improvement in late HMR and improvement in peak oxygen consumption (r 0.547, P < .001). CONCLUSION: In our study, baseline cardiac denervation predicted response and clinical outcomes after CRT implantation. Cardiac sympathetic function was improved only in patients who responded to CRT and these positive changes were correlated with improvement in functional capacity.
Entities:
Keywords:
Heart failure; cardiac innervation; diagnostic and prognostic application
Authors: Michael R Bristow; Leslie A Saxon; John Boehmer; Steven Krueger; David A Kass; Teresa De Marco; Peter Carson; Lorenzo DiCarlo; David DeMets; Bill G White; Dale W DeVries; Arthur M Feldman Journal: N Engl J Med Date: 2004-05-20 Impact factor: 91.245
Authors: Ana Carolina Alba; Matthew W Adamson; J MacIsaac; Spencer D Lalonde; Wai S Chan; Diego Hernan Delgado; Heather Joan Ross Journal: J Card Fail Date: 2016-02-01 Impact factor: 5.712
Authors: Yong-Mei Cha; Panithaya Chareonthaitawee; Ying-Xue Dong; Bradley J Kemp; Jae K Oh; Chinami Miyazaki; David L Hayes; Robert F Rea; Samuel J Asirvatham; Tracy L Webster; Connie M Dalzell; David O Hodge; Regina M Herges; Yan-Zhong Yong; Yanhua Zhang; Peng-Sheng Chen Journal: Circ Heart Fail Date: 2011-03-18 Impact factor: 8.790
Authors: Roberto M Lang; Luigi P Badano; Victor Mor-Avi; Jonathan Afilalo; Anderson Armstrong; Laura Ernande; Frank A Flachskampf; Elyse Foster; Steven A Goldstein; Tatiana Kuznetsova; Patrizio Lancellotti; Denisa Muraru; Michael H Picard; Ernst R Rietzschel; Lawrence Rudski; Kirk T Spencer; Wendy Tsang; Jens-Uwe Voigt Journal: Eur Heart J Cardiovasc Imaging Date: 2015-03 Impact factor: 6.875
Authors: Arnold F Jacobson; Roxy Senior; Manuel D Cerqueira; Nathan D Wong; Gregory S Thomas; Victor A Lopez; Denis Agostini; Fred Weiland; Harish Chandna; Jagat Narula Journal: J Am Coll Cardiol Date: 2010-02-25 Impact factor: 24.094
Authors: John G F Cleland; Jean-Claude Daubert; Erland Erdmann; Nick Freemantle; Daniel Gras; Lukas Kappenberger; Luigi Tavazzi Journal: N Engl J Med Date: 2005-03-07 Impact factor: 91.245
Authors: Anna I Mishkina; Victor V Saushkin; Tariel A Atabekov; Svetlana I Sazonova; Vladimir V Shipulin; Samia Massalha; Roman E Batalov; Sergey V Popov; Konstantin V Zavadovsky Journal: J Nucl Cardiol Date: 2022-07-14 Impact factor: 3.872
Authors: D O Verschure; E Poel; G De Vincentis; V Frantellizzi; K Nakajima; O Gheysens; J R de Groot; H J Verberne Journal: Eur Heart J Cardiovasc Imaging Date: 2021-01-01 Impact factor: 6.875