I-123-mIBG myocardial imaging for assessment of risk for a major cardiac event in heart failure patients:: insights from a retrospective European multicenter study
I-123-mIBG 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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DOI：
10.1007/s00259-007-0639-3
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发表时间：
2008-03-01
影响因子：
9.1
通讯作者：
Jacobson, Arnold F.
中科院分区：
文献类型：
--
作者：
Agostini, Denis;Verberne, Hein J.;Jacobson, Arnold F.
目的单中心经验表明，心肌间碘苄胍（mIBG）摄取对心力衰竭（HF）患者具有预后价值。为了使用严格的临床试验方法来验证这些观察结果，对欧洲6个中心10年期间获得的一系列心脏I-123-mIBG扫描进行回顾性回顾和前瞻性定量再分析。方法对290例HF患者进行I-123-mIBG扫描[（262例左室射血分数（LVEF）< 50%）]采用标准化方法重新分析延迟平面图像上的心脏-纵隔比率（H/M）。所有图像结果均由三名独立评审员进行验证。主要心脏事件[MCE;结果MCE发生在67名患者（26%）中：MCE组的平均H/M比率为1.51 +/- 0.30，非MCE组为1.97 +/- 0.54（p < 0.001）。使用最佳H/M比阈值1.75，H/M比小于1.75的2年无事件生存率为62%，H/M比大于或等于1.75的2年无事件生存率为95%（p < 0.0001）。Logistic回归显示H/M比值和LVEF是MCE的唯一显著预测因素。使用H/M的下四分位数1.45和上四分位数2.17作为高风险和极低风险阈值，2年无事件生存率分别为52%和98%。在LVEF = 1.75的患者中（n = 73），有9例MCE是由于进行性HF，只有1例是由于心律失常.结论通过回顾性再分析I-123-mIBG图像的临床试验方法的应用证实了先前报道的该方法在HF患者中的预后价值，包括对心脏死亡和潜在致命性室性心律失常的低风险的定量阈值的潜在识别。
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 I-123-mIBG scans acquired during a 10-year period at six centers in Europe.Methods I-123-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 = 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 I-123-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.