Cardiac sympathetic activity in chronic heart failure: cardiac 123I-mIBG scintigraphy to improve patient selection for ICD implantation

Abstract

Heart failure is a life-threatening disease with a growing incidence in the Netherlands. This growing incidence is related to increased life expectancy, improvement of survival after myocardial infarction and better treatment options for heart failure. As a consequence, the costs related to heart failure care will increase. Despite huge improvements in treatment, the prognosis remains unfavourable with high one-year mortality rates. The introduction of implantable devices such as implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) has improved the overall survival of patients with chronic heart failure. However, after ICD implantation for primary prevention in heart failure a high percentage of patients never have appropriate ICD discharges. In addition 25–50 % of CRT patients have no therapeutic effect. Moreover, both ICDs and CRTs are associated with malfunction and complications (e. g. inappropriate shocks, infection). Last but not least is the relatively high cost of these devices. Therefore, it is essential, not only from a clinical but also from a socioeconomic point of view, to optimise the current selection criteria for ICD and CRT. This review focusses on the role of cardiac sympathetic hyperactivity in optimising ICD selection criteria. Cardiac sympathetic hyperactivity is related to fatal arrhythmias and can be non-invasively assessed with 123I-meta-iodobenzylguanide (123I-mIBG) scintigraphy. We conclude that cardiac sympathetic activity assessed with 123I-mIBG scintigraphy is a promising tool to better identify patients who will benefit from ICD implantation.

The Effects of Continuous Positive Airway Pressure on Premature Ventricular Contractions and Ventricular Wall Stress in Patients with Heart Failure and Sleep Apnea

“…Heart failure is a life-threatening disease with a growing incidence in developed countries due to better treatment options for heart failure, improvement of survival after myocardial infarction, and increased life expectancy. The introduction of implantable devices such as implantable cardioverter defibrillators (ICD) has improved the overall survival of patients with heart failure [ 20 ]. ICD treatment reduces mortality in patients with heart failure.…”

The Possibilities of Myocardium Scintigraphy With 99mtc-Mibi and 123i-Mibg For Optimization of the Icd Defibrillant Electrode Location in Patients With Cad: The Comparative Study

“…The myocardium scintigraphy with 123I-MIBG in recent years have become very widespread, due to the proved fact of its diagnostic value in predicting cardiac death, progression of heart failure, the occurrence of life-threatening arrhythmias in patients with heart failure [11]. It is believed that the nervous tissue of the heart is more sensitive to ischemia than the muscular tissue, so the defects of accumulation of 123I-MIBG in patients with CAD are larger in size compared with the defects of accumulation of perfusion radiopharmaceuticals [12].…”

“…In a number of studies, the higher significance of SPECT with 123I-MIBG was shown in comparison with myocardial perfusion scintigraphy in the prognosis of motivated shocks of ICD, implanted for primary prevention of sudden cardiac death [11].…”

Effect of Empagliflozin Versus Placebo on Cardiac Sympathetic Activity in Acute Myocardial Infarction Patients with Type 2 Diabetes Mellitus: Rationale

“…Compared with individuals without diabetes, those with diabetes are at a 56% greater risk of death from an ST elevation myocardial infarction heart attack and at a 39% greater risk of death from a non-ST elevation MI [ 6 ]. Cardiac sympathetic hyperactivity is related to poor prognosis and fatal arrhythmias [ 7 ]. To date, noninvasive techniques such as T-wave alternans (TWA), late potentials (LP), heart rate turbulence (HRT), and heart rate variability (HRV) have been developed for this purpose.…”