Skip to main content

Advertisement

SpringerLink
Log in

Importance of renal function on prognostic value of cardiac iodine-123 metaiodobenzylguanidine scintigraphy

  • Original Articles
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective: Cardiac iodine-123 metaiodobenzylguanidine (MIBG) can be used to evaluate cardiac sympathetic nerve function and is useful for assessing the prognosis of patients with heart disease. Renal impairment in heart failure patients has been recognized as an independent risk factor for morbidity and mortality, and has been observed as abnormal uptake and washout of cardiac MIBG imaging. The purpose of this study was to evaluate the prognostic value of cardiac MIBG imaging in heart disease patients with a glomerular filtration rate (GFR) either ≥60 ml/min/1.73 m2 or <60 ml/min/1.73 m2.Methods: Heart disease patients (n: 135, male/female: 87/48, mean age: 63 years, coronary artery disease/dilated cardiomyopathy/myocarditis: 41/62/32, mean left ventricular ejection fraction: 51%, GFR ≥60 ml/min/1.73 m2/GFR <60 ml/min/1.73 m2:103/32) underwent cardiac MIBG imaging and were followed-up for 2.7 years. GFR was calculated by the Modification of Diet in Renal Disease (MDRD) equation. Cardiac MIBG imaging was obtained 15 min and 4 h after isotope injection. The parameters analyzed for cardiac MIBG imaging were the heart-to-mediastinum ratio (H/M) on the delayed planar image and the cardiac washout rate.Results: Cardiac death was observed in 9 of 103 patients (9%) with a GFR >-60 ml/min/1.73 m2 and in 6 of 32 patients (19%) with a GFR <60 ml/min/1.73 m2. The mortality ratio tended to be higher in patients with a GFR <60 ml/min/1.73 m2 than in patients with a GFR ≥60 ml/min/1.73 m2 (p=0.10 with Kaplan-Meier survival curves). In patients with a GFR ≥60 ml/min/1.73 m2, Cox regression analysis showed that a delayed H/M <146% was the most powerful predictor for cardiac death (Hazard ratio: 6.9, p=0.014). However, in patients with a GFR <60 ml/min/1.73 m2, the utility of cardiac MIBG imaging could not be proved.Conclusions: A delayed H/M is a powerful predictor of cardiac death if the GFR is 60 ml/min/1.73 m2 or more.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hasking GJ, Esler MD, Jennings GL, Burton D, Johns JA, Korner PI. Norepinephrine spillover to plasma in congestive heart failure: evidence of increased cardiorenal and total sympathetic nerve activity.Circulation 1986; 73: 615–621.

    PubMed  CAS  Google Scholar 

  2. Cohn JN, Levine BT, Olivari MT, Garberg V, Lura D, Francis GS, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure.N Engl J Med 1984; 311: 819–823.

    PubMed  CAS  Google Scholar 

  3. Wieland DM, Brown LE, Rogers WL, Worthington KC, Wu JL, Clinthome NH, et al. Myocardial imaging with radioiodinated norepinephrine storage analog.J Nucl Med 1981; 22: 22–31.

    PubMed  CAS  Google Scholar 

  4. Kline RC, Swanson DP, Wieland DM, Thrall JH, Gross MD, Pitt B, et al. Myocardial imaging in man with I-123 meta-iodobenzylguanidine.J Nucl Med 1981; 22: 129–132.

    PubMed  CAS  Google Scholar 

  5. Sisson JC, Shapiro B, Meyers L, Mallette S, Mangner TJ, Wieland DM, et al. Metaiodobenzylguanidine to map scintigraphically the adrenergic nervous system in man.J Nucl Med 1987; 28: 1625–1636.

    PubMed  CAS  Google Scholar 

  6. Schofer J, Spielmann R, Schuchert A, Weber K, Schuluter M. Iodine-123 meta-iodobenzylguanidine scintigraphy: a noninvasive method to demonstrate myocardial adrenergic nervous system disintegrity in patients with idiopathic dilated cardiomyopathy.J Am Coll Cardiol 1988; 12: 1252–1258.

    Article  PubMed  CAS  Google Scholar 

  7. Henderson EB, Kahn JK, Corbett JR, Jansen DE, Pippin JJ, Kulkarni P, et al. Abnormal I-123 metaiodobenzylguanidine myocardial washout and distribution may reflect myocardial adrenergic derangement in patients with congestive cardiomyopathy.Circulation 1988; 78: 1192–1199.

    PubMed  CAS  Google Scholar 

  8. Glowniak JV, Turner FE, Gray LL, Palac RT, Lagunas-Solar MC, Woodward WR. Iodine-123 metaiodobenzyl-guanidine imaging of the heart in idiopathic congestive cardiomyopathy and cardiac transplants.J Nucl Med 1989; 30: 1182–1191.

    PubMed  CAS  Google Scholar 

  9. Imamura Y, Ando H, Mitsuoka W, Egashira S, Masaki H, Ashihara T, et al. Iodine-123 metaiodobenzylguanidine images reflect intense myocardial adrenergic nervous activity in congestive heart failure independent of underlying cause.J Am Coll Cardiol 1995; 26: 1594–1599.

    Article  PubMed  CAS  Google Scholar 

  10. Wakabayashi T, Nakata T, Hashimoto A, Yuda S, Tsuchihashi K, Travin MI, et al. Assessment of underlying etiology and cardiac sympathetic innervation to identify patients at high risk of cardiac death.J Nucl Med 2001; 42: 1757–1767.

    PubMed  CAS  Google Scholar 

  11. Merlet P, Valette H, Dubois-Rande JL, Moyse D, Duboc D, Dore P, et al. Prognostic value of cardiac metaiodobenzyl-guanidine imaging in patients with heart failure.J Nucl Med 1992; 33: 471–477.

    PubMed  CAS  Google Scholar 

  12. Merlet P, Benvenuti C, Moyse D, Pouillant F, Dubois-Rande JL, Dural AM, et al. Prognostic value of MIBG imaging in idiopathic dilated cardiomyopathy.J Nucl Med 1999; 40: 917–923.

    PubMed  CAS  Google Scholar 

  13. Momose M, Kobayashi H, Iguchi N, Matsuda N, Sakomura Y, Kasanuki H, et al. Comparison of parameters of123I-MIBG scintigraphy for predicting prognosis in patients with dilated cardiomyopathy.Nucl Med Commun 1999; 20: 529–535.

    Article  PubMed  CAS  Google Scholar 

  14. Ogita H, Shimonagata T, Fukunami M, Kumagai K, Yamada T, Asano Y, et al. Prognostic significance of cardiac123I metaiodobenzylguanidine imaging for mortality and morbidity in patients with chronic heart failure: a prospective study.Heart 2001; 86: 656–660.

    Article  PubMed  CAS  Google Scholar 

  15. Imamura Y, Fukuyama T, Mochizuki T, Miyagawa M, Watanabe K; Ehime MIBG Heart Failure Study Investigators. Prognostic value of iodine-123-metaiodobenzylguanidine imaging and cardiac natriuretic peptide levels in patients with left ventricular dysfunction resulting from cardiomyopathy.Jpn Circ J 2001; 65: 155–160.

    Article  PubMed  CAS  Google Scholar 

  16. Imamura Y, Fukuyama T. Prognostic value of myocardial MIBG scintigraphy findings in patients with cardiomyopathy—importance of background correction for quantification of MIBG activity.Ann Nucl Med 2002; 16: 387–393.

    Article  PubMed  Google Scholar 

  17. Nakata T, Miyamoto K, Doi A, Sasao H, Wakabayashi T, Kobayashi H, et al. Cardiac death prediction and impaired cardiac sympathetic innervation assessed by MIBG in patients with failing and non-failing hearts.J Nucl Cardiol 1998; 5: 579–590.

    Article  PubMed  CAS  Google Scholar 

  18. Cohen-Solal A, Esanu Y, Logeart D, Pessione F, Dubois C, Dreyful G, et al. Cardiac metaiodobenzylguanidine uptake in patients with moderate chronic heart failure: relationship with peak oxygen uptake and prognosis.J Am Coll Cardiol 1999; 33: 759–766.

    Article  PubMed  CAS  Google Scholar 

  19. Hillege HL, Girbes ARJ, de Kam PJ, Boomsta F, de Zeeuw D, Charlesworth A, et al. Renal function, neurohormonal activation, and survival in patients with chronic heart failure.Circulation 2000; 102: 203–210.

    PubMed  CAS  Google Scholar 

  20. Kurata C, Wakabayashi Y, Shouda S, Okayama K, Yamamoto T, Ishikawa A, et al. Enhanced cardiac clearance of iodine-123-MIBG in chronic renal failure.J Nucl Med 1995; 36: 2037–2043.

    PubMed  CAS  Google Scholar 

  21. Kurata C, Uehara A, Sugi T, Ishikawa A, Fujita K, Yonemura K, et al. Cardiac autonomic neuropathy in patients with chronic renal failure on hemodialysis.Nephron 2000; 84: 312–319.

    Article  PubMed  CAS  Google Scholar 

  22. Blake GM, Lewington VJ, Zivanovic MA, Ackery DM. Glomerular filtration rate and kinetics of I-123-metaiodobenzylguanidine.Eur J Nucl Med 1989; 15: 618–623.

    PubMed  CAS  Google Scholar 

  23. Al-Ahmad A, Rand WM, Manjunath G, Konstam MA, Salem DN, Lerey AS, et al. Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction.J Am Coll Cardiol 2001; 38: 955–962.

    Article  PubMed  CAS  Google Scholar 

  24. Braunwald E, Colucci WS, Grossman W. Clinical aspects of heart failure: high-output heart failure-pulmonary edema. In: Braunwald E, edHeart disease: A Textbook of Cardiovascular Medicine. Philadelphia, PA; WB Saunders, 1997: 445–470.

    Google Scholar 

  25. Wafelman AR, Nortier YL, Rosing H, Maessen HJ, Taal BG, Hoefnagel CA, et al. Renal excretion of metaiodobenzylguanidine after therapeutic doses in cancer patients and its relation to dose and creatinine clearance.Nucl Med Commun 1995; 16: 767–772.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, 153-8515, Tokyo, Japan

    Tatsuhiko Furuhashi & Masao Moroi M.D.

Authors
  1. Tatsuhiko Furuhashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masao Moroi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masao Moroi M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Furuhashi, T., Moroi, M. Importance of renal function on prognostic value of cardiac iodine-123 metaiodobenzylguanidine scintigraphy. Ann Nucl Med 21, 57–63 (2007). https://doi.org/10.1007/BF03034000

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03034000

Key words

Search

Navigation