Prognostic value of cardiac I-123 metaiodobenzylguanidine imaging in patients with non–insulin-dependent diabetes mellitus

Abstract

MIBG myocardial scintigraphy was useful for predicting cardiac events and long-term mortality in NIDDM.

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

“…Cardiac 123 I-mIBG imaging is currently indicated for ''scintigraphic assessment of sympathetic innervation of the myocardium in patients with New York Heart Association [NYHA] class II or class III HF and left ventricular ejection fraction [LVEF] B35% … and to help identify patients with lower oneand two-year mortality risks, as indicated by an [HMR] ratio C1.6.'' Nevertheless, much literature suggests a potential broader use, 91 including identification of patients at increased risk of lethal cardiac arrhythmias in the setting of HF, [92][93][94][95] evaluating primary arrhythmic conditions, [96][97][98][99][100] assessing the presence and risk of ischemic heart disease, 101,102 including in situations of hibernating myocardium 103,104 and post-infarction, [105][106][107] evaluating pre-and post-cardiac transplant patients, [108][109][110] identifying diabetic patients at increased risk from cardiac autonomic dysfunction, 111,112 and monitoring toxicity from chemotherapy. 113 However, based on currently available literature, published guidelines, and the FDA package insert, the following indications can be recommended: 114 • For patients with NYHA class II or III heart failure with LVEF B35% to help stratify risk and to promote more informed clinical decision-making when the result of 123 I-mIBG study is likely to influence the decision regarding ICD implant.…”

Heart rate response during vasodilator stress myocardial perfusion imaging: Mechanisms and implications

“…Imaging using I-123 metaiodobenzylguanidine (MIBG), a nonmetabolized norepinephrine analogue, has been used to aid in the diagnosis of cardiac autonomic denervation and has been shown to be prognostically useful in DM and heart failure patients. 15,16 Indeed, in dogs, the induction of sustained ventricular tachycardia after myocardial infarction has been shown to be associated with a larger area of myocardial perfusion-innervation mismatch as assessed by [13N]-ammonia and [11C]-epinephrine positron emission tomography. 17 Abidov et al were the first to report on the prognostic significance of the HR change after adenosine infusion.…”

Effect of angiotensin-converting enzyme inhibitors on systemic inflammation and myocardial sympathetic innervation in normotensive patients with type 2 diabetes mellitus

“…14 123 I-MIBG myocardial scintigraphy is a useful tool for diagnosing cardiac autonomic neuropathy and, in combination with other clinical data, it contributes to predicting cardiac events and long-term mortality in non-insulin-dependent DM. 15 Recent evidence suggests that ACE-i can be advantageous for the prevention and halting the progression of both micro-and macrovascular complications in patients with DM. 6 However, the latest findings indicate that the action of ACE-i in diabetes is independent of its effect on BP and could benefit even those patients who have not exhibited hypertension.…”

“…The majority of our patients showed decreased values of H/M and myocardial adrenergic innervation defects, which are thought to be due to functional and structural disturbances caused by an increase in sympathetic activity. 21 More specifically, these phenomena might be the result of either a decreased number of cardiac sympathetic nerve endings, a decreased function type 1 uptake, or accelerated release from storage vesicles. Our 123 I-MIBG findings with ACE-i are consistent with those in cardiovascular diseases that involve cardiac sympathetic overactivity, such as heart failure and essential hypertension.…”