Prognostic significance of cardiac 123I metaiodobenzylguanidine imaging for mortality and morbidity in patients with chronic heart failure: a prospective study

Abstract

Objective-To determine whether cardiac iodine-123 metaiodobenzylguanidine ( 123 I MIBG) imaging is useful in predicting the prognosis of patients with chronic heart failure. Design-Cardiac123 I MIBG imaging was done on entry to the study. The cardiac MIBG washout rate was calculated from anterior chest view images obtained 20 and 200 minutes after injection of the isotope. Study patients were divided into two groups with washout rates above and below 27% (the mean value + 2 SD obtained in 20 normal subjects), and were then followed up. Setting-Tertiary referral centre. Patients-79 patients with chronic heart failure in whom the left ventricular ejection fraction was less than 40%. Results-There were 37 patients in group 1 (washout rate of > 27%) and 42 in group 2 (< 27%). During a follow up period of between 1 and 52 months, eight patients died suddenly and five died of worsening heart failure in group 1, while none died in group 2; 13 patients in group 1 and four in group 2 were admitted to hospital for progressive heart failure. Kaplan-Meier analysis showed that group 1 had a significantly higher mortality and morbidity (p = 0.001 and p < 0.001, respectively) than group 2. Conclusions-Cardiac 123

Essential role of sympathetic endothelin A receptors for adverse cardiac remodeling

“…2A). To address the question of whether depleted myocardial NE stores were mediated-at least in part-by a reduced NE reuptake via the NE transporter (NET), we used the [ 124 I]-MIBG-PET method to assess cardiac NET activity in vivo (17,18,26). This method does not directly measure cardiac sympathetic activity but serves as an index for cardiac sympathetic activity.…”

“…Thus, an ET A i trial with this small HF patient cohort might be an interesting approach to test the hypothesis that patients without antiadrenergic therapy might benefit from ET A i. Moreover, imaging techniques such as [ 123 I]-MIBG uptake (17,18,26) that allow an assessment of the sympathetic nerve function in patients may serve as a tool for the selection of patients that benefit in particular from ET A i.…”

“…The success of HF therapy with adrenergic receptor antagonists that inhibit the target receptor of NE in adult CMs underscores the pivotal role of NE in HF (16). Consequently, the mechanisms by which NE is released from sympathetic neurons impact on signaling cascades in CMs (17)(18)(19). We now hypothesized that ET A i mediates their…”

Cardiac autonomic imaging with SPECT tracers

“…68 Cardiac 123 I-mIBG WR has been investigated by Ogita et al, showing that patients with washout C27% had a 35% 4-year cardiac death rate compared with no deaths for a normal WR, and a threefold increase in HF hospital admissions in the high WR group. 55 Another study from this group reported that increased WR predicted SCD. 69 Upon meta-analysis of literature from 18 prior studies, a total of 1,755 patients, Verberne et al reported that abnormal WR had a pooled hazard ratio (HR) of 1.72 (P = .006) for cardiac death, and a HR of 1.08 (P \ .001) for cardiac events (cardiac death, MI, transplant, HF hospitalization); in the three best studies reported for late H/M, there was a HR of 1.82 (P = .015) for cardiac death and 1.98 (P \ .001) for cardiac events.…”

“…53,54 Increased sympathetic activity, reflecting worsened HF, is associated with diminished myocardial 123 I-mIBG retention on delayed images and thus a higher myocardial WR. 55 Although various methods of washout determination are reported, recent European guidelines indicate the following 36 :…”