Role of cardiac (123)I-mIBG imaging in predicting arrhythmic events in stable chronic heart failure patients with an ICD.
Role of cardiac (123)I-mIBG imaging in predicting arrhythmic events in stable chronic heart failure patients with an ICD.
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DOI：
10.1007/s12350-018-1258-z
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发表时间：
2019-08
期刊：
影响因子：
--
通讯作者：
Verberne HJ
中科院分区：
文献类型：
--
作者：
De Vincentis G;Frantellizzi V;Fedele F;Farcomeni A;Scarparo P;Salvi N;Fegatelli DA;Mancone M;Verschure DO;Verberne HJ
尽管治疗有所改善，但慢性心力衰竭（CHF）的预后仍然不利，部分原因是心律失常和心源性猝死（SCD）。这项前瞻性研究评估心肌123i -间碘苄基胍（123I-mIBG）显像作为心衰患者心律失常事件（AE）的预测因子。纳入了170例用于一级和二级预防的植入式心脏转复除颤器（ICD）植入的CHF患者。所有患者均行平面和SPECT显像。计算早期和晚期心脏与纵隔（H/M）比、123I-mIBG冲洗（WO）、早期和晚期SPECT总评分。主要终点为AE：持续性室性心动过速、复苏性心脏骤停、适当的ICD治疗或SCD。次要终点是适当的ICD治疗。在中位23.3个月的随访期间，69例患者出现AE。早期总评分（ESS）是AE的唯一独立预测因子[HR 1.023(1.003-1.043)]。仅关注用于一级预防的ICD患者，ESS是AE的唯一独立预测因子[HR 1.028(1.007-1.050)]。123i - mibg衍生参数不能作为适当ICD治疗的独立预测因子。然而，123I-mIBG闪烁图衍生参数与AE及适当的ICD治疗呈“钟形”关系，即123I-mIBG中度异常的患者发生事件的风险更高。虽然SPECT 123I-mIBG闪烁成像与ICD植入一级和二级预防的CHF患者的AE相关，但123I-mIBG闪烁成像衍生参数与适当的ICD治疗之间没有关联。本文的在线版本（10.1007/s12350-018-1258-z）包含补充资料，仅供授权用户使用。
Despite therapeutic improvement, the prognosis of chronic heart failure (CHF) remains unfavorable partly due to arrhythmia and sudden cardiac death (SCD). This prospective study evaluated myocardial 123I-meta-iodobenzylguanidine (123I-mIBG) scintigraphy as a predictor of arrhythmic events (AE) in CHF patients. 170 CHF patients referred for implantable cardioverter-defibrillator (ICD) implantation for both primary and secondary prevention were enrolled. All patients underwent planar and SPECT imaging. Early and late heart-to-mediastinum (H/M) ratio, 123I-mIBG washout (WO), early and late summed SPECT scores were calculated The primary endpoint was an AE: sustained ventricular tachycardia, resuscitated cardiac arrest, appropriate ICD therapy or SCD. The secondary endpoint was appropriate ICD therapy. During a median follow-up of 23.3 months, 69 patients experienced an AE. Early summed score (ESS) was the only independent predictor of AE [HR 1.023 (1.003-1.043)]. Focussing on only patients with an ICD for primary prevention, ESS was the only independent predictor of AE [HR 1.028 (1.007-1.050)]. 123I-mIBG-derived parameters failed to be independent predictors of appropriate ICD therapy. However there was a “bell-shaped” relation between 123I-mIBG scintigraphy-derived parameters and AE and appropriate ICD therapy, i.e., those with intermediate 123I-mIBG abnormalities tended to be at higher risk of events. Although SPECT 123I-mIBG scintigraphy was associated with AE in CHF patients with ICD implantation for primary and secondary prevention, no association was found between 123I-mIBG scintigraphy-derived parameters and appropriate ICD therapy. The online version of this article (10.1007/s12350-018-1258-z) contains supplementary material, which is available to authorized users.
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