123I-MIBG imaging in heart failure: impact of comorbidities on cardiac sympathetic innervation

Abstract

Purpose Heart failure (HF) is a primary cause of morbidity and mortality worldwide, with significant impact on life quality and extensive healthcare costs. Assessment of myocardial sympathetic innervation function plays a central role in prognosis assessment in HF patients. The aim of this review is to summarize the most recent evidence regarding the clinical applications of iodine-123 metaiodobenzylguanidine (123I-MIBG) imaging in patients with HF and related comorbidities. Methods A comprehensive literature search was conducted on PubMed and Web of Science databases. Articles describing the impact of 123I-MIBG imaging on HF and related comorbidities were considered eligible for the review. Results We collected several data reporting that 123I-MIBG imaging is a safe and non-invasive tool to evaluate dysfunction of cardiac sympathetic neuronal function and to assess risk stratification in HF patients. HF is frequently associated with comorbidities that may affect cardiac adrenergic innervation. Furthermore, HF is frequently associated with comorbidities and chronic conditions, such as diabetes, obesity, kidney disease and others, that may affect cardiac adrenergic innervation. Conclusion Comorbidities and chronic conditions lead to more severe impairment of sympathetic nervous system in patients with HF, with a negative impact on disease progression and outcome. Cardiac imaging with 123I-MIBG can be a useful tool to reduce morbidity and prevent adverse events in HF patients.

Cardiac sympathetic innervation and mortality risk scores in patients with heart failure

“…In this scenario, repeated evidence has shown that alterations in 123 I-MIBG imaging parameters represent independent prognostic factors, even when advanced age, comorbidities and chronic conditions (chronic kidney disease, diabetes and obesity) negatively concur to disease progression and outcome. 33 The ADMIRE-HF study included 964 patients with HF in NYHA class II-III to determine the independent predictive value of 123 I-MIBG imaging on all-cause mortality and on a composite endpoint of death/death-equivalent events. The authors demonstrated, through multiple multivariate risk modelling, the impact of cardiac sympathetic innervation on patient outcomes compared with other clinical measurements including brain natriuretic peptide (BNP) levels and LVEF.…”

“…Nonetheless, it is worth mentioning that the assessment of the risk/benefit ratio is often particularly challenging in the clinical practice, even in areas in which the different factors contributing to outcomes intrinsically overlap, making it difficult to discriminate the relative contribution of each component. In this scenario, repeated evidence has shown that alterations in 123 I‐MIBG imaging parameters represent independent prognostic factors, even when advanced age, comorbidities and chronic conditions (chronic kidney disease, diabetes and obesity) negatively concur to disease progression and outcome 33 . The ADMIRE‐HF study included 964 patients with HF in NYHA class II–III to determine the independent predictive value of 123 I‐MIBG imaging on all‐cause mortality and on a composite endpoint of death/death‐equivalent events.…”

Novel Strategies in Diagnosing Heart Failure with Preserved Ejection Fraction: A Comprehensive Literature Review

“…Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy is a safe and helpful imaging technique to evaluate cardiac innervation [ 29 ]. Although this technique has been widely studied in HFrEF, current knowledge regarding cardiac sympathetic innervation in HFpEF is limited.…”

Spirocyclic Iodonium Ylides for Fluorine‐18 Radiolabeling of Non‐Activated Arenes: From Concept to Clinical Research

“…We previously discussed another phenethylguanidine radiotracer, [ 18 F]mFBG, for neuro‐oncology applications (see section 3.2 ). Both [ 123 I]MIBG and [ 18 F]mFBG is a NET‐targeted radiotracer, which can also be used in cardiology for imaging myocardial presynaptic nerve density [70] [48] .…”

“…Both [ 123 I]MIBG and [ 18 F]mFBG is a NETtargeted radiotracer, which can also be used in cardiology for imaging myocardial presynaptic nerve density. [70] Our recent collaboration with the Rotstein lab described the optimized and automated radiosynthesis of [ 18 F]mFBG in RCYs of 24 � 1% with A m of 30-95 GBq/μmol. [48] Preclinical cardiac PET studies in healthy rats revealed favourable uptake (~3 SUV) and monoexponential washout kinetics.…”