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1.
Serial change of iodine-123 metaiodobenzylguanidine (MIBG) myocardial concentration in patients with dilated cardiomyopathy 总被引:1,自引:1,他引:0
K. Yamakado K. Takeda T. Kitano T. Nakagawa Y. Futagami T. Konishi M. Hamada T. Nakano T. Ichihara 《European journal of nuclear medicine and molecular imaging》1992,19(4):265-270
Serial change of the metaiodobenzylguanidine iodine-123 (123I-MIBG) myocardial concentration was investigated in patients with dilated cardiomyopathy (DCM). Eight DCM patients and 6 control subjects were examined. After the injection of thallium-201 and 123I-MIBG, planar chest images were obtained simultaneously for both tracers in every 30–60 min over 5 h. Serial changes of myocardial uptake ratio (MUR) were compared for both tracers. In DCM, the initial MUR of 123I-MIBG did not differ significantly from that of the controls. The washout of 123I-MIBG from the myocardium, however, was significantly increased in DCM. In particular, the decrease in the early phase (15–45 min) was significantly larger in DCM than in the controls (21.2%±7.5% vs. 5.3%±4.0%, P <0.01), showing a significant negative correlation with the left ventricular ejection fraction (r = –0.72 P < 0.05). For 201TI, neither the initial MUR nor the washout rate different significantly between the two. Thus, an early rapid decrease of the 123I-MIBG myocardial concentration might characterize DCM and reflect the severity of this disease.
Offprint requests to: K. Yamakado 相似文献
2.
K Yamakado K Takeda T Kitano T Nakagawa Y Futagami T Konishi M Hamada T Nakano T Ichihara 《European journal of nuclear medicine》1992,19(4):265-270
Serial change of the metaiodobenzylguanidine iodine-123 (123I-MIBG) myocardial concentration was investigated in patients with dilated cardiomyopathy (DCM). Eight DCM patients and 6 control subjects were examined. After the injection of thallium-201 and 123I-MIBG, planar chest images were obtained simultaneously for both tracers in every 30-60 min over 5 h. Serial changes of myocardial uptake ratio (MUR) were compared for both tracers. In DCM, the initial MUR of 123I-MIBG did not differ significantly from that of the controls. The washout of 123I-MIBG from the myocardium, however, was significantly increased in DCM. In particular, the decrease in the early phase (15-45 min) was significantly larger in DCM than in the controls (21.2% +/- 7.5% vs. 5.3% +/- 4.0%, P less than 0.01), showing a significant negative correlation with the left ventricular ejection fraction (r = -0.72 P less than 0.05). For 201Tl, neither the initial MUR nor the washout rate different significantly between the two. Thus, an early rapid decrease of the 123I-MIBG myocardial concentration might characterize DCM and reflect the severity of this disease. 相似文献
3.
4.
T Tanaka T Aizawa K Kato H Nakano M Igarashi T Ueno K Hirosawa K Kusakabe 《Kaku igaku. The Japanese journal of nuclear medicine》1989,26(2):257-261
I-123 Metaiodobenzylguanidine (MIBG) is taken up by myocardial sympathetic neuronal endings. Sympathetic neuronal function in 10 patients with cardiomyopathy under stable state were studied by using MIBG and Tl-201 (Tl) SPECT images with 50% cut off level. For myocardial imaging MIBG and Tl were simultaneously injected and collected (dual injection and dual collection mode; Dd mode). Four hours delayed images were also collected. Three types of abnormal findings were noted in MIBG images in combination with Tl images. 1) Enhancement of regional MIBG washout with otherwise normal MIBG and Tl uptake in infero-lateral wall were noted in 5 patients with history of congestive heart failure (Pathophysiologically acceleration of regional sympathetic neuronal function was suspected. Mean washout ratio is 63 +/- 7% vs. 45 +/- 10% in normal region). 2) In 3 patients with dilated cardiomyopathy increase of MIBG/Tl (M/T) ratio was noted in basal septal wall (Sympathetic neuronal function is abnormally accelerated in the region with depressed coronary perfusion. Exaltation of regional sympathetic neuronal function was suspected. Mean M/T ratio is 1.6. Tentative normal range is from 0.8 to 1.20). 3) In 2 patients with dilated cardiomyopathy under severe congestive heart failure defects of MIBG uptake with normal Tl uptake were noted (Sympathetic neuronal function was depleted in spite of normal coronary perfusion. Depletion of myocardial catecolamine was suspected. M/T ratio is 0.75 and 0.7 respectively). Heterogeneous abnormality of sympathetic neuronal function was noted in MIBG images. This findings corresponded to report about heterogeneous myocardial catecholamine concentrations in hearts of recipients of transplantation.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
5.
K Nakajima H Bunko J Taki M Shimizu I Nanbu A Muramori I Matsunari K Hisada 《Kaku igaku. The Japanese journal of nuclear medicine》1990,27(1):33-38
Single-photon emission computed tomography was performed in 29 patients with hypertrophic cardiomyopathy (HCM) using 123I-metaiodobenzylguanidine (MIBG). Segmental myocardial uptake of MIBG and 201T1 was calculated in 21 patients with primary HCM without history of hypertension. Septal thickness was measured by echocardiography and the relationship to septal MIBG uptake was studied. Initial MIBG uptake and 201T1 uptake showed positive correlation with the septal thickness (R = 0.581, p = 0.0058 and R = 0.677, p = 0.0007). When the septal MIBG uptake was divided by the corresponding 201T1 uptake (MIBG/T1), both the early and delayed MIBG/T1 showed negative correlation with the septal thickness (R = -0.485, p = 0.0255 and R = -0.535, p = 0.0125). Significant positive correlation was observed between septal MIBG clearance and the thickness (R = 0.510, p = 0.0182). In patients with severe septal hypertrophy (greater than 20 mm), the MIBG clearance was significantly higher compared with less hypertrophic (less than or equal to 20 mm) group (13.4 +/- 8.0%/hr vs. 3.2 +/- 4.7%/hr, p = 0.0028). Thus, MIBG was useful for the evaluation of sympathetic innervation and activity in HCM. The MIBG clearance and uptake in conjunction with 201T1 study seemed to reflect the severity of hypertrophy in HCM. 相似文献
6.
Conclusion The study of Parthenakis et al4 represents a step toward further documenting the relationship between myocardial blood flow,
left ventricular wall motion, and presynaptic sympathetic neuronal function in the disease process of idiopathic dilated cardiomyopathy.
However, more questions remain to be answered. With a large future increase predicted in the number of patients developing
congestive heart failure, perhaps it is time for carefully planned imaging studies to be incorporated into new clinical trials
of medical therapies for heart failure. These may provide further important information concerning the utility of quantitative
MIBG imaging in assessing pathophysiology, approaches to medical therapy, and prediction of prognosis in patients with idiopathic
dilated cardiomyopathy. 相似文献
7.
Caroline E. Veltman Mark J. Boogers Joris E. Meinardi Imad Al Younis Petra Dibbets-Schneider Ernst E. Van der Wall Jeroen J. Bax Arthur J. H. A. Scholte 《European journal of nuclear medicine and molecular imaging》2012,39(10):1599-1608
Purpose
Despite its high prognostic value, widespread clinical implementation of 123I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy is hampered by a lack of validation and standardization. The purpose of this study was to assess the reliability of planar 123I-MIBG myocardial scintigraphy in patients with heart failure (HF).Methods
Planar myocardial MIBG images of 70 HF patients were analysed by two experienced and one inexperienced observer. The reproducibility of early and delayed heart-to-mediastinum (H/M) ratios, as well as washout rate (WR) calculated by two different methods, was assessed using the intraclass correlation coefficient (ICC) and the Bland-Altman analysis. In addition, a subanalysis in patients with a very low H/M ratio (delayed H/M ratio <1.4) was performed. The delayed H/M ratio was also assessed using fixed-size oval and circular cardiac regions of interest (ROI).Results
Intra- and interobserver analyses and experienced versus inexperienced observer analysis showed excellent agreement for the measured early and delayed H/M ratios and WR on planar 123I-MIBG images (the ICCs for the delayed H/M ratios were 0.98, 0.96 and 0.90, respectively). In addition, the WR without background correction resulted in higher reliability than the WR with background correction (the interobserver Bland-Altman 95?% limits of agreement were ?2.50 to 2.16 and ?10.10 to 10.14, respectively). Furthermore, the delayed H/M ratio measurements remained reliable in a subgroup of patients with a very low delayed H/M ratio (ICC 0.93 for the inter-observer analysis). Moreover, a fixed-size cardiac ROI could be used for the assessment of delayed H/M ratios, with good reliability of the measurement.Conclusion
The present study showed a high reliability of planar 123I-MIBG myocardial scintigraphy in HF patients, confirming that MIBG myocardial scintigraphy can be implemented easily for clinical risk stratification in HF. 相似文献8.
9.
T Saito N Watanabe T Saitoh T Asakura M Kanke K Owada K Hoshi K Kimura Y Maruyama 《Kaku igaku. The Japanese journal of nuclear medicine》1990,27(11):1301-1306
A crosstalk from I-123 to Tl-201 (Tl) window was 35 +/- 30% (mean +/- SD) and 30 +/- 10% in a myocardial phantom and the images of 6 patients respectively. However, the crosstalk from Tl to I-123 was approximately 1% in each. I-123 MIBG (MIBG) and Tl myocardial SPECT images were recorded in 3 normal volunteers (N), 10 patients with myocardial infarction (MI), and 4 with dilated cardiomyopathy (DCM). The MIBG and Tl imagings were performed on the other day to avoid the crosstalk. Myocardial washout rates (WR) of Tl and MIBG were derived from 15 min and 4 hour images. WR of Tl was approximately 36% in each group. On the other hand, WR of MIBG in DCM (52 +/- 7%) and MI (41 +/- 14%) groups were statistically higher than in N (24 +/- 7%) group. Thus WR of MIBG would be useful to detect abnormalities in adrenergic nervous system. 相似文献
10.
Yahara Y Nomura Y Okamoto S Saitou K Okamoto R Makino K Aoki S Takeda K 《Kaku igaku. The Japanese journal of nuclear medicine》2000,37(3):217-225
BACKGROUND: Quantification of 123I-metaiodobenzylguanidine (MIBG) myocardial uptake is widely accepted as a useful tool for estimating the severity of congestive heart failure. However, most reliable method has not been determined yet because of the difficulty of background (BG) subtraction. In this study, the most appropriate BG subtraction method was evaluated as compared with plasma atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), norepinephrine (NEP) and left ventricular ejection fraction (LVEF). METHODS: Twenty-one patients with chronic heart failure were examined. After bolus injection of 123I-MIBG (111 MBq), dynamic anterior chest images were collected every second for 2 minutes. Planar anterior chest images were obtained 15 minutes (early image) and 4 hours later (delayed image) respectively. The parameters for quantification of 123I-MIBG myocardial uptake used in this study were heart to mediastinum ratio (H/M), myocardial washout rate and uptake ratio. Background was calculated using the region of interest (ROI) placed over a part of upper mediastinum, whole upper mediastinum, right lung and pericardial space respectively. The values of these parameters were calculated with and without BG subtraction and compared with plasma ANP, BNP and others. RESULTS: H/M did not correlate with ANP or BNP. Myocardial washout rate without BG subtraction showed significant correlation with ANP (p < 0.01) and BNP (p < 0.05). After BG subtraction employing ROI placed over the part of upper mediastinum and whole upper mediastinum, myocardial washout rate showed better correlation with BNP (p < 0.01). Myocardial uptake ratio did not showed any correlation with ANP or BNP without BG subtraction. However, myocardial uptake ratio showed significant correlation with BNP (p < 0.05) after subtraction of upper mediastinal BG. BG subtraction using ROI over right lung or pericardial area revealed poor results in both myocardial washout rate- and uptake ratio. CONCLUSION: BG subtraction using ROI over the upper mediastinum is likely to be suitable for quantitative analysis of 123I-MIBG myocardial scintigram. 相似文献
11.
Keiichiro Yoshinaga Yuuki Tomiyama Osamu Manabe Katsuhiko Kasai Chietsugu Katoh Kenichi Magota Eriko Suzuki Ken-ichi Nishijima Yuji Kuge Yoichi M. Ito Nagara Tamaki 《Annals of nuclear medicine》2014,28(8):761-769
Objectives
123I-metaiodobenzylguanidine (MIBG) has been used to estimate cardiac sympathetic nervous innervation. Heterogeneous MIBG distribution is mainly associated with high physiological MIBG uptakes in the liver. We postulate that prone position acquisition might be especially effective for MIBG, providing for separation from high liver uptake similar to that provided by perfusion single-photon emission computed tomography (SPECT). We investigated whether prone-position acquisition improved MIBG image quality by comparing our results to those acquired using supine MIBG and high-quality 11C-hydroxyephedrine (HED) positron emission tomography/computed tomography PET/CT.Methods
Ten male volunteers (body mass index (BMI) 22.7 ± 3.4) underwent prone and supine MIBG and HED PET. Relative regional tracer uptake was estimated in early MIBG and HED. Acquired images were divided into 17 segments and were grouped into 4 regions: anterior, inferior, septum, and lateral. For each patient, the inferior/anterior ratio was calculated.Results
The quality of images acquired using prone MIBG was better than that using supine MIBG (p < 0.05). Inferior and septum relative MIBG uptake was reduced in comparison with anterior or lateral MIBG uptake in the supine position (inferior vs. anterior: 69.0 ± 5.6 vs. 82.3 ± 4.6 %, p < 0.01; septum vs. lateral: 66.2 ± 5.1 vs. 81.9 ± 5.4 %, p < 0.01). Prone MIBG showed a significantly higher inferior/anterior uptake ratio in comparison with supine MIBG (n = 24, seg: 92.2 ± 7.2 vs. 83.6 ± 5.7 %, p < 0.05). However, intergroup differences in uptake ratio were demonstrated among prone and supine MIBG and HED. HED PET/CT still showed a higher uptake ratio in comparison with prone MIBG SPECT (103.9 ± 8.0 vs. 92.2 ± 7.2 %, p < 0.05).Conclusion
Even in normal male subjects, standard supine MIBG imaging showed reduced inferior and septum uptake. Uptake with prone MIBG imaging showed a significant improvement over that with supine imaging and was closer to uptake for HED PET/CT. This improvement may be the result of preventing intense uptake by the liver. Prone data acquisition may be a viable alternative in evaluating regional abnormalities using MIBG SPECT in men. 相似文献12.
Kasama S Toyama T Kaneko Y Iwasaki T Sumino H Kumakura H Minami K Ichikawa S Matsumoto N Sato Y Kurabayashi M 《European journal of nuclear medicine and molecular imaging》2012,39(6):1056-1064
Purpose
Late ventricular potentials (LPs) are considered to be useful for identifying patients with heart failure at risk of developing ventricular arrhythmias. 123I-metaiodobenzylguanidine (MIBG) scintigraphy, which is used to evaluate cardiac sympathetic activity, has demonstrated cardiac sympathetic denervation in patients with malignant ventricular tachyarrhythmias. This study was undertaken to clarify the relationship between LPs and 123I-MIBG scintigraphy findings in patients with dilated cardiomyopathy (DCM).Methods
A total of 56 patients with DCM were divided into an LP-positive group (n?=?24) and an LP-negative group (n?=?32). During the compensated period, the delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined from 123I-MIBG images and plasma brain natriuretic peptide (BNP) concentrations were measured. Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF) were simultaneously determined by echocardiography.Results
LVEDV, LVESV, LVEF and plasma BNP concentrations were similar in the two groups. However, TDS was significantly higher (35?±?8 vs. 28?±?6, p?0.005), the H/M ratio was significantly lower (1.57?±?0.23 vs. 1.78?±?0.20, p?0.005), and the WR was significantly higher (60?±?14% vs. 46?±?12%, p?0.001) in the LP-positive than in the LP-negative group. The average follow-up time was 4.5?years, and there were nine sudden deaths among the 56 patients (16.1%). In logistic regression analysis, the incidences of sudden death events were similar in those LP-negative with WR <50%, LP-negative with WR ≥50% and LP-positive with WR <50% (0%, 10.0% and 14.3%, respectively), but was significantly higher (41.2%) in those LP-positive with WR ≥50% (p?0.01, p?0.05, and p?0.05, respectively).Conclusion
The present study demonstrated that the values of cardiac 123I-MIBG scintigraphic parameters were worse in LP-positive DCM patients than in LP-negative DCM patients. Furthermore, in LP-positive DCM patients with a high WR, the incidence of sudden death events was higher than that in other subgroups of DCM patients. 相似文献13.
Meguro K Toyama T Adachi H Ohshima S Taniguchi K Nagai R 《Annals of nuclear medicine》2007,21(1):73-78
OBJECTIVE: Iodine-123 MIBG imaging has been used to study cardiac sympathetic function in various cardiac diseases. Central sleep apnea syndrome (CSAS) occurs frequently in patients with chronic heart failure (CHF) and is reported to be associated with a poor prognosis. One of the mechanisms of its poor prognosis may be related to impaired cardiac sympathetic activity. However, the relationship between chemosensitivity to carbon dioxide, which is reported to correlate with the severity of CSAS, and cardiac sympathetic activity has not been investigated. Therefore, this study was undertaken to assess cardiac sympathetic function and chemosensitivity to carbon dioxide in CHF patients. METHODS: The oxygen desaturation index (ODI) was evaluated in 21 patients with dilated cardiomyopathy (male/female: 19/2, LVEF < 45%, 65 +/- 12 yr). Patients with an ODI > 5 times/h underwent polysomnography. Patients with an apnea hypopnea index > 15/h but without evidence of obstructive apnea were defined as having CSAS. Early (15 min) and delayed (4 hr) planar MIBG images were obtained from these patients. The mean counts in the whole heart and the mediastinum were obtained. The heart-to-mediastinum count ratio of the delayed image (H/M) and the corrected myocardial washout rate (WR) were also calculated. The central chemoreflex was assessed with the rebreathing method using a hypercapnic gas mixture (7% CO2 and 93% O2). RESULTS: Ten of the 21 patients had CSAS. The H/M ratio was similar in patients both with and without CSAS (1.57 +/- 0.18 vs. 1.59 +/- 0.14, p = 0.82). However, the WR was higher in patients with CSAS than in patients without CSAS (40 +/- 8% vs. 30 +/- 12%, p < 0.05). ODI significantly correlated with central chemosensitivity to carbon dioxide. Moreover, there was a highly significant correlation between WR and central chemosensitivity (r = 0.65, p < 0.05). However, there was no correlation between ODI and the WR (r = 0.36, p = 0.11). CONCLUSIONS: Cardiac sympathetic nerve activity in patients with CHF and CSAS is impaired. However, central sleep apnea might not directly increase cardiac sympathetic nerve activity. We suggest that central chemosensitivity, which is considered to be one of the mechanisms of CSAS, is correlated with cardiac sympathetic nerve activity. 相似文献
14.
U Lotze S Kaepplinger A Kober B M Richartz D Gottschild H R Figulla 《Journal of nuclear medicine》2001,42(1):49-54
In chronic heart failure, elevated plasma norepinephrine (NE) levels and a disparity between the neuronal release and the effective reuptake of NE lead to an increased concentration of NE in the presynaptic cleft, causing a downregulation of the myocardial beta-adrenoceptors. The clinical and prognostic effectiveness of beta-blocker therapy has been shown in patients with chronic heart failure in several large trials. The purpose of this study was to investigate the effect of long-term beta-blocker therapy on the cardiac adrenergic nervous system as assessed by the myocardial uptake of 123I-metaiodobenzylguanidine (MIBG), an analog of NE, in idiopathic dilated cardiomyopathy (IDC). METHODS: In 10 patients with IDC and stable chronic heart failure the myocardial MIBG uptake was measured at baseline and at 1 y (median, 11.5 mo) after treatment with beta-blockers (metoprolol, n = 5; bisoprolol, n = 1; and carvedilol, n = 4) in addition to standard medication. In parallel with the changes in MIBG uptake, the New York Heart Association functional class, the left ventricular ejection fraction (LVEF), and the left ventricular end-diastolic diameter (LVEDD) were documented before and after 1 y of therapy with beta-blockers. Results: During the 1-y follow-up, a significant increase in myocardial 123I-MIBG uptake (P = 0.005) in parallel with an improved LVEF (P = 0.005) and a reduced LVEDD (P = 0.019) was found. A trend toward an improvement of the New York Heart Association functional class under the beta-blocker therapy (P = 0.139) was also found. CONCLUSION: Assessment of the myocardial 123I-MIBG uptake is a useful noninvasive tool for evaluating changes in cardiac sympathetic nerve activity under medical therapy. Long-term treatment with beta-blockers in IDC causes a recovery of the cardiac adrenergic nervous system concomitantly with a clinical and hemodynamic improvement. 相似文献
15.
Nagamachi S Jinnouchi S Kurose T Nishii R Kawai K Futami S Tamura S Matsukura S 《Annals of nuclear medicine》2002,16(1):33-38
PURPOSE: We performed 123I-MIBG (MIBG) myocardial scintigraphy twice in patients with non-insulin-dependent diabetes mellitus (NIDDM) to investigate whether MIBG distribution was improved by pertinent clinical control. To determine the influential factors for MIBG distribution, we investigated the association between various clinical parameters and the serial change in MIBG uptake parameters. PATIENTS AND METHODS: Twenty NIDDM patients with no cardiac disorders were evaluated. Planar images were taken at 30 minutes (early) and 3 hours (delayed) after MIBG injection. The heart-to-upper-mediastinum uptake ratio (H/M) and washout ratio (WR) were calculated as parameters for estimating cardiac sympathetic function. Patients were divided into two groups, eight in the improved group and twelve in the unimproved group, according to the serial change in H/M. The mean interval between the baseline and the follow up study was 2.1 +/- 0.6 year. Differences between the means of the laboratory data in patients in both groups were compared for the baseline and the follow up study by using the paired t-test. As a means of determining the influential factors for a serial change of MIBG uptake, Fisher's exact test was performed to evaluate the association between the serial change in cardiac MIBG parameters and changes in other clinical parameters, such as blood sugar (BS) control, BS control method (insulin therapy), serum cholesterol control, and severity of diabetic complications. We also analyzed the association between the changes in CV(R-R) (coefficient variance of R-R intervals at rest ECG) or NCV (velocity of posterior tibial nerve) and those of other clinical parameters. Associations among these neurological parameters (MIBG parameters, CV(R-R) and NCV) were also analyzed. RESULTS: Paired t-tests showed a significant decrease in fasting blood sugar and fructosamine in the improved group in the follow up study compared to those in the baseline study. Nevertheless, Fisher's exact test showed no significant association between FBS, HbA1C, fructosamine and the improvement in cardiac MIBG uptake. The only significant association was observed between the serial change in H/M and the BS-control method (insulin therapy). Within the neurological parameters, a significant association was noted between the serial changes in H/M and CV(R-R). CONCLUSION: Although BS control was likely to be an important factor, it did not always ameliorate cardiac MIBG uptake. Based on the significant association between the BS-control method (insulin therapy) and MIBG uptake change, the severity of diabetes mellitus was likely to be a more influential factor. It was suggested that cardiac MIBG uptake could improve within the mild stage if controlled by diet therapy or an oral hypoglycemic agent in NIDDM. 相似文献
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17.
Prognostic value of MIBG imaging in idiopathic dilated cardiomyopathy. 总被引:24,自引:0,他引:24
P Merlet C Benvenuti D Moyse F Pouillart J L Dubois-Randé A M Duval D Loisance A Castaigne A Syrota 《Journal of nuclear medicine》1999,40(6):917-923
Alterations of cardiac sympathetic innervation are likely to contribute to fatal outcomes in patients with heart failure. These alterations can be evaluated noninvasively by 123I-metaiodoben-zylguanidine (MIBG) imaging. METHODS: The hypothesis that impaired cardiac sympathetic innervation, as assessed using MIBG imaging, is related to adverse outcomes was tested in 112 patients with heart failure resulting from idiopathic cardiomyopathy. Main inclusion criteria were New York Heart Association classes II-IV and radionuclide left ventricular ejection fraction (LVEF) < 40%. Patients were assessed for cardiac MIBG uptake, circulating norepinephrine concentration, LVEF, peak Vo2, x-ray cardiothoracic ratio, M-mode echographic end-diastolic diameter and right-sided heart catheterization parameters. RESULTS: During a mean follow-up of 27 +/- 20 mo, 19 patients had transplants, 25 died of cardiac death (8 sudden deaths), 2 died of noncardiac death and 66 survived without transplantation. The only independent predictors for mortality were low MIBG uptake (P < 0.001) and LVEF (P = 0.02) when using multivariate discriminant analysis. Moreover, MIBG uptake (P < 0.001) and circulating norepinephrine concentration (P = 0.001) were the only independent predictors for life duration when using multivariate life table analysis. CONCLUSION: Impaired cardiac adrenergic innervation as assessed by MIBG imaging is strongly related to mortality. MIBG imaging may help risk stratify patients with heart failure resulting from idiopathic dilated cardiomyopathy. 相似文献
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19.
Satoru Ohshima Satoshi Isobe Daisuke Hayashi Shinji Abe Katsuhiko Kato Toyoaki Murohara 《European journal of nuclear medicine and molecular imaging》2013,40(2):262-270
Purpose
We investigated whether myocardial 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy predicts impairment of myocardial functional reserve in response to dobutamine stress in patients with idiopathic dilated cardiomyopathy (DCM).Methods
Forty DCM patients (LVEF 39?±?12 %) underwent myocardial 123I-MIBG scintigraphy, echocardiography, and cardiac catheterization. Myocardial 123I-MIBG uptake was quantified as the delayed heart to mediastinum (H/M) ratio and washout rate (WR). Local denervation was evaluated on polar map images. LV dP/dt max and T1/2 were determined from left ventricular pressure curves at baseline and during dobutamine infusion (15 μg/kg?/min). Patients were classified into two groups as follows: group A comprised 21 patients showing a delayed H/M ratio of <1.9 (median value); group B comprised 19 patients showing a delayed H/M ratio of ≥1.9.Results
The percentage change in heart rate (%HR), LV dP/dt max (%LV dP/dt max), and T 1/2 (%T 1/2) from baseline to dobutamine stress were significantly more reduced in group A than in group B (39.3?±?20.2 %, 55.2?±?24.1 %, p?<?0.01; 102.3?±?46.3 %, 152.0?±?72.3 %, p?<?0.05; 38.7?±?15.3 %, 46.9?±?15.4 %, p?<?0.05, respectively). No significant differences between the two groups were observed in the echocardiographic parameters or baseline cardiac catheterization parameters. Significant correlations were found between delayed H/M ratio and %HR (r?=?0.35, p?<?0.05), %LV dP/dt max (r?=?0.45, p?<?0.05) and %T 1/2 (r?=?0.34, p?<?0.05). Significant inverse correlations were also found between WR and %HR (r?=??0.37, p?<?0.05), %LV dP/dt max (r?=??0.60, p?<?0.0001), and %T 1/2 (r?=??0.34, p?<?0.05). SPECT images revealed enhanced denervation from the inferoposterior to anterior wall in accordance with the advancement of global denervation.Conclusion
Reduced 123I-MIBG uptake and increased washout were related to impairment in adrenergic myocardial functional reserve in idiopathic DCM. 相似文献20.
Verberne HJ Habraken JB van Eck-Smit BL Agostini D Jacobson AF 《European journal of nuclear medicine and molecular imaging》2008,35(3):547-553
Background There is lack of validation and standardisation of acquisition parameters for myocardial 123I-metaiodobenzylguanidine (MIBG). This lack of standardisation hampers large scale implementation of 123I-MIBG parameters in the evaluation of patients with chronic heart failure (CHF).
Methods In a retrospective multi-centre study 123I-MIBG planar scintigrams obtained on 290 CHF patients (82% male; 58% dilated cardiomyopathy; New York Heart Association [NYHA
classification] > I) were reanalysed to determine the late heart-to-mediastinum ratio (H/M).
Results There was a large variation in acquisition parameters. Multivariate forward stepwise regression showed that a significant
proportion (31%, p < 0.001) of the variation in late H/M could be explained by a model containing patient-related variables and acquisition
parameters. Left ventricular ejection fraction (p < 0.001), type of collimation (p < 0.001), acquisition duration (p = 0.001), NYHA class (p = 0.028) and age (p = 0.034) were independent predictors of late H/M.
Conclusions Acquisitions parameters are independent contributors to the variation of semi-quantitative measurements of cardiac 123I-MIBG uptake. Improved standardisation of cardiac 123I-MIBG imaging parameters would contribute to increased clinical applicability for this procedure. 相似文献