Comparison of the prognostic value of cardiac iodine-123 metaiodobenzylguanidine imaging and heart rate variability in patients with chronic heart failure

Abstract

Cardiac MIBG WR has a higher prognostic value than HRV parameters in patients with chronic HF. The combination of abnormal WR and n-VLFP would be useful to identify chronic HF patients at a higher risk of cardiac events.

How to use myocardial 123I-MIBG scintigraphy in chronic heart failure

“…In a heterogeneous population of patients with heart failure, the most important determinant of cardiac uptake of 123 I-MIBG is the degree of impairment of the norepinephrine transporter function in presynaptic adrenergic neurons [2][3][4][5][6][7][8][9][10]. As such, considerable variation in late H/M ratio would be expected between patients with otherwise similar clinical presentations (NYHA class, LVEF, etc).…”

“…In the past two decades, a large number of investigators have demonstrated decreased myocardial 123 I-MIBG uptake in patients with chronic heart failure (CHF) and have shown that those with the lowest uptake tend to have the poorest prognosis [2][3][4][5][6][7][8][9][10][11][12]. There have also been findings suggesting that abnormalities of myocardial 123 I-MIBG uptake may be predictive of increased risk of ventricular arrhythmia and sudden cardiac death [13,14].…”

What will be the role of I-123 MIBG in improving the outcome of medically treated heart failure patients?

“…These multiple variables affecting heart rate variability, as well as the technical limitations in heart rate variability measurement, limit its potential to detect changes in cardiac sympathetic activity that may alter response to adjustment of medical therapy. 52,53 In studies directly comparing heart rate variability to I-123 MIBG imaging, I-123 MIBG imaging was predictive of all-cause mortality 54 and for either cardiac death or hospitalization for HF, 55 whereas heart rate variability was not.…”

Cardiac autonomic imaging with SPECT tracers

“…48 In another, an ROI is drawn around the epicardial border and the valve plane, including the LV cavity. 49 Finally, some use an ROI encompassing the myocardium alone, tracing the epicardial and endocardial borders, excluding the valve plane and cavity. 50 Interestingly, all methods appear to give similar result.…”