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Incremental prognostic value of myocardial neuroadrenergic damage in patients with chronic congestive heart failure: An iodine-123 meta-iodobenzylguanidine scintigraphy study

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

ICD in primary prevention reduced mortality in patients with heart failure (HF); however, in about 80% of the ICD recipients an event requiring a device intervention will never occur. Thus, a reliable screening test included in a multiparametric approach to appropriately select patients to ICD implantation is increasingly required. Aim of the work was to assess if the Iodine-123 Meta-Iodobenzylguanidine scintigraphy (123I-mIBG) could be useful to identify patients with HF who would not benefit from the ICD implantation because at low risk of arrhythmias.

Methods and results

This is a retrospective multicentre study on patients undergoing 123I-mIBG from February 2012 to December 2015. Inclusion criteria where: age ≥ 18 years old, LVEF ≤ 35% with idiopathic or ischemic heart disease, no previous malignant ventricular arrhythmias. Patients were divided in two groups based on of late H/M < or ≥ 1.60 on 123I-mIBG. Primary end-point was occurrence of malignant arrhythmias. Secondary end-point was occurrence of cardiac death and hospitalization for worsening HF. MACE were mortality and malignant arrhythmias. Eighty-one patients were enrolled (mean age: 69 years). On 123I-mIBG, 54 patients had late H/M < 1.6 and 27 patients had late H/M ≥ 1.60. After a mean follow-up of 13.3 (± 9.7) months, the primary end-point occurred in 13 patients out of 81. No arrhythmias occurred in patients with H/M late ≥ 1.6. Nineteen patients out of 20 with MACE showed an H/M late < 1.6. Death in group with H/M ≥ 1.6 occurred for worsening HF. A late H/M ≥ 1.60 showed a very high NPV for arrhythmia (100%) and for death (96.3%).

Conclusion

123I-mIBG imaging has the capability to identify patients at low risk of events.

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Abbreviations

123I-mIBG:

Iodine-123 meta-iodobenzylguanidine

HF:

Heart failure

H/M:

Heart/mediastinum ratio

ICD:

Implantable cardioverter defibrillators

LVEF:

Left ventricular ejection fraction

MACE:

Major adverse cardiac events

NYHA:

New York Heart Association

VF/VT:

Ventricular fibrillation/ventricular tachicardia

WOR:

Washout rate

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Disclosure

The authors declare that they have no conflict of interest to disclose.

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Authors and Affiliations

  1. Cardiology Department, Ospedale Santa Croce Moncalieri, Moncalieri, Italy

    Scrima Giovanni MD, Spinnler Maria Teresa MD, Cannillo Margherita MD & Gambino Alfonso MD

  2. Division of Cardiology, SS Trinita’ Hospital, ASL No, Borgomanero, NO, Italy

    Maffè Stefano MD, Parravicini Umberto MD, Paffoni Paola MD & Dellavesa Pierfranco MD

  3. Nuclear Medicine Department, Ospedale Santa Croce Moncalieri, Moncalieri, Italy

    Bertuccio Giovanni MD & Canavese Giacomo MD

  4. IRCCS Nuclear Medicine Department, Maugeri Clinical Scientific Institute, Veruno, Italy

    Campini Riccardo MD

  5. IRCCS Cardiology Department, Maugeri Clinical Scientific Institute, Veruno, Italy

    Marcassa Claudio MD

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Correspondence to Scrima Giovanni MD.

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Giovanni, S., Stefano, M., Teresa, S.M. et al. Incremental prognostic value of myocardial neuroadrenergic damage in patients with chronic congestive heart failure: An iodine-123 meta-iodobenzylguanidine scintigraphy study. J. Nucl. Cardiol. 27, 1787–1797 (2020). https://doi.org/10.1007/s12350-018-01467-0

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