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Prognostic effect and modulation of cardiac sympathetic function in heart failure patients treated with cardiac resynchronization therapy

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Cardiac autonomic dysfunction as assessed by 123I-metaiodobenzylguanidine (123I-mIBG) scintigraphy is associated with poor prognosis in heart failure (HF) patients. Although cardiac resynchronization therapy (CRT) has emerged as an effective therapy in improving outcomes on HF patients, its effect on cardiac sympathetic nervous function is still not fully understood. We aimed to study the value of pre-implantation 123I-mIBG late heart-to-mediastinum ratio (HMR) as a predictor of response and outcomes after CRT and to correlate modification in this parameter with CRT response and functional improvement.

Methods and Results

BETTER-HF (Benefit of exercise training therapy and cardiac resynchronization in HF patients) is a prospective randomized clinical trial including HF patients submitted CRT (mean LVEF 24 ± 8%, 74% NYHA class ≥ III) who underwent a clinical, echocardiographic, and scintigraphic assessment before and 6 months after CRT. One-hundred and twenty-one patients were included. Echocardiographic response was observed in 54% and composite outcome of cardiac mortality, cardiac transplant or heart failure hospitalization in 24% of patients. Baseline late HMR was an independent predictor of CRT response (regression coefficient 2.906, 95% CI 0.293-3.903, P .029) and outcomes (HR 0.066 95% CI 0.005-0.880, P .040). At follow-up, 123I-mIBG imaging showed positive changes in cardiac sympathetic nerve activity only in responders to CRT (1.36 ± 0.14 prior vs. 1.42 ± 0.16 after CRT, P .039). There was a significant correlation between improvement in late HMR and improvement in peak oxygen consumption (r 0.547, P < .001).

Conclusion

In our study, baseline cardiac denervation predicted response and clinical outcomes after CRT implantation. Cardiac sympathetic function was improved only in patients who responded to CRT and these positive changes were correlated with improvement in functional capacity.

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Abbreviations

HF:

Heart failure

123I-mIBG:

123I-metaiodobenzylguanidine

HMR:

Heart-to-mediastinum ratio

CRT:

Cardiac resynchronization therapy

LVEF:

Left ventricular ejection fraction

LVESV:

Left ventricle end-systolic volume

VO2:

Oxygen consumption

BNP:

Brain natriuretic peptide

Hs-CRP:

High-sensitive C-reactive protein

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Disclosures

Rita Ilhão Moreira, Ana Abreu, Guilherme Portugal, Luís Oliveira, Mário Oliveira, Inês Rodrigues, Madalena Coutinho Cruz, Pedro Silva Cunha, Vanessa Santos, Helena Santa Clara, Rui Cruz Ferreira, Miguel Mota Carmo have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, 1169-024, Lisbon, Portugal

    Rita Ilhão Moreira MD, Ana Abreu MD, PhD, Guilherme Portugal MD, Mário Oliveira MD, PhD, Inês Rodrigues MD, Madalena Coutinho Cruz MD, Pedro Silva Cunha MD, Miguel Mota Carmo MD, PhD & Rui Cruz Ferreira MD

  2. Nuclear Medicine Department, Medical and Diagnosis Clinic Quadrantes, Lisbon, Portugal

    Luís Oliveira MD

  3. CIPER, Human Kinetics Faculty, University of Lisbon, Lisbon, Portugal

    Vanessa Santos SB & Helena Santa Clara SB, PhD

  4. NOVA Medical School, New University of Lisbon, Lisbon, Portugal

    Miguel Mota Carmo MD, PhD

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  1. Rita Ilhão Moreira MD
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  2. Ana Abreu MD, PhD
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Correspondence to Rita Ilhão Moreira MD.

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Moreira, R.I., Abreu, A., Portugal, G. et al. Prognostic effect and modulation of cardiac sympathetic function in heart failure patients treated with cardiac resynchronization therapy. J. Nucl. Cardiol. 27, 283–290 (2020). https://doi.org/10.1007/s12350-018-1357-x

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