Renal Function in Relation to Cardiac ¹²³I-MIBG Scintigraphy in Patients with Chronic Heart Failure

Abstract

The aim of this study was to explore if estimates of renal function could explain variability of 123I-metaiodobenzylguanidine (123I-MIBG) assessed myocardial sympathetic activity. Furthermore estimates of renal function were compared to 123I-MIBG as predictors of cardiac death in chronic heart failure (CHF). Semi-quantitative parameters of 123I-MIBG myocardial uptake and washout were calculated using early heart/mediastinum ratio (H/M), late H/M and washout. Renal function was calculated as estimated Creatinine Clearance (e-CC) and as estimated Glomerular Filtration Rate (e-GFR). Thirty-nine patients with CHF (24 males; age: 64.4 ± 10.5 years; NYHA II/III/IV: 17/20/2; LVEF: 24.0 ± 11.5%) were studied. Variability in any of the semi-quantitative 123I-MIBG myocardial parameters could not be explained by e-CC or e-GFR. During follow-up (60 ± 37 months) there were 6 cardiac deaths. Cox proportional hazard regression analysis showed that late H/M was the only independent predictor for cardiac death (Chi-square 3.2, regression coefficient: −4.095; standard error: 2.063; hazard ratio: 0.17 [95% CI: 0.000–0.950]). Addition of estimates of renal function did not significantly change the Chi-square of the model. Semi-quantitative 123I-MIBG myocardial parameters are independent of estimates of renal function. In addition, cardiac sympathetic innervation assessed by 123I-MIBG scintigraphy seems to be superior to renal function in the prediction of cardiac death in CHF patients.

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

“…In chronic HF patients, impaired cardiac sympathetic innervation assessed by 123 I-MIBG activity has been associated with reduced kidney function and increased risk of cardiac death [36]. Accordingly, Verschure and colleagues investigated the different predictive potentials of 123 I-MIBG imaging and GFR on outcomes in patients with chronic HF and found that 123 I-MIBG scintigraphy was a better predictor of cardiac death, compared to the evaluation of renal function [37]. In a subsequent study, Malhotra et al found a prevalence of cardiac sympathetic dysfunction in patients with both HF and renal dysfunction.…”