I-123-<Emphasis Type="Italic">m</Emphasis>IBG myocardial imaging for assessment of risk for a major cardiac event in heart failure patients: insights from a retrospective European multicenter study |
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Authors: | Denis Agostini Hein J Verberne Wolfgang Burchert Juhani Knuuti Pavol Povinec Gianmario Sambuceti Mustafa Unlu Montserrat Estorch Gopa Banerjee Arnold F Jacobson |
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Institution: | (1) CHU Cote de Nacre, Caen, France;(2) Academic Medical Centre, Amsterdam, The Netherlands;(3) Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeyenhausen, Germany;(4) Turku University Central Hospital, Turku, Finland;(5) Comenius University School of Medicine, Bratislava, Slovakia;(6) University of Genova, Genova, Italy;(7) Gazi University, Ankara, Turkey;(8) Hospital Sant Pau, Barcelona, Spain;(9) GE Healthcare, Princeton, NJ, USA |
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Abstract: | Purpose Single-center experiences have shown that myocardial meta-iodobenzylguanidine (mIBG) uptake has prognostic value in heart failure (HF) patients. To verify these observations using a rigorous clinical trial
methodology, a retrospective review and prospective quantitative reanalysis was performed on a series of cardiac 123I-mIBG scans acquired during a 10-year period at six centers in Europe.
Methods
123I-mIBG scans obtained on 290 HF patients (262 with left ventricular ejection fraction (LVEF) < 50%)] from 1993 to 2002 were
reanalyzed using a standardized methodology to determine the heart-to-mediastinum ratio (H/M) on delayed planar images. All
image results were verified by three independent reviewers. Major cardiac events MCEs; cardiac death, cardiac transplant,
potentially fatal arrhythmia (including implantable cardioverter-defibrillator discharge)] during 24-month follow-up were
confirmed by an adjudication committee.
Results MCEs occurred in 67 patients (26%): mean H/M ratio was 1.51 ± 0.30 for the MCE group and 1.97 ± 0.54 for the non-MCE group
(p < 0.001). Two-year event-free survival using an optimum H/M ratio threshold of 1.75 was 62% for H/M ratio less than 1.75,
95% for H/M ratio greater than or equal to 1.75 (p < 0.0001). Logistic regression showed H/M ratio and LVEF as the only significant predictors of MCE. Using the lower and upper
H/M quartiles of 1.45 and 2.17 as high- and very low-risk thresholds, 2-year event-free survival rates were 52% and 98%, respectively.
Among patients with LVEF ≤ 35% and H/M ≥ 1.75 (n = 73), there were nine MCEs because of progressive HF and only one because of an arrhythmia.
Conclusion Application of a clinical trial methodology via the retrospective reanalysis of 123I-mIBG images confirms the previously reported prognostic value of this method in HF patients, including potential identification
of a quantitative threshold for low risk for cardiac mortality and potentially fatal ventricular arrhythmias. |
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Keywords: | Cardiology mIBG Scintigraphy Nuclear imaging Prognosis |
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