Assessment of 123I-mIBG and 99mTc-tetrofosmin single-photon emission computed tomographic images for the prediction of arrhythmic events in patients with ischemic heart failure: Intermediate severity innervation defects are associated with higher arrhythmic risk
Assessment of 123I-mIBG and 99mTc-tetrofosmin single-photon emission computed tomographic images for the prediction of arrhythmic events in patients with ischemic heart failure: Intermediate severity innervation defects are associated with higher arrhythmic risk
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DOI：
10.1007/s12350-015-0336-8
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发表时间：
2017-04-01
影响因子：
2.4
通讯作者：
Verberne, Hein J.
中科院分区：
文献类型：
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作者：
Travin, Mark I.;Henzlova, Milena J.;Verberne, Hein J.
I-123-mIBG平面图像心脏与纵隔比率可有效地对心力衰竭（HF）患者进行风险分层。单光子发射计算机断层扫描（SPECT）成像识别室性心律失常风险增加的价值尚不清楚。本研究旨在确定I-123-mIBG和Tc-99 m-tetrofosmin SPECT同时解读的结果是否可以预测心律失常事件（战神）。来自622名缺血性HF患者的I-123-mIBG SPECT图像与Tc-99 m-tetrofosmin图像一起以标准显示器呈现。使用17段模型的共识解释产生了总分。考克斯比例风险分析相关结果裁定战神超过2年。471例患者的图像足以进行总的17段评分。有48例（10.2%）战神。I-123-mIBG和Tc-99 m-tetrofosmin SPECT总分均不是单变量预测因子。在多变量比例风险分析中，I-123-mIBG SPECT评分独立预测战神（HR：0.975，95% CI 0.951-0.999，P = 0.042），但HR < 1表明风险随评分增加而降低。这是因为与广泛异常的患者相比，中度异常SPECT研究的患者发生战神的可能性更高。ArE风险随I-123-mIBG SPECT总评分增加而单调增加的假设可能不正确，因为中度异常的缺血性HF患者出现风险最高。
I-123-mIBG planar image heart-to-mediastinum ratios effectively risk-stratify heart failure (HF) patients. The value of single-photon emission computed tomographic (SPECT) imaging for identifying increased risk of ventricular arrhythmias is less clear. This study sought to determine if findings from simultaneous interpretation of I-123-mIBG and Tc-99m-tetrofosmin SPECT are predictive of arrhythmic events (ArEs).I-123-mIBG SPECT images from 622 patients with ischemic HF were presented in standard displays alongside Tc-99m-tetrofosmin images. Consensus interpretations using a 17-segment model produced summed scores. Cox proportional hazards analyses related findings to adjudicated ArEs over 2 years.471 patients had images adequate for total 17-segment scoring. There were 48 ArEs (10.2%). Neither I-123-mIBG nor Tc-99m-tetrofosmin SPECT summed scores were univariate predictors. On multivariate proportional hazards analysis, the I-123-mIBG SPECT score was independently predictive of ArEs (HR: 0.975, 95% CI 0.951-0.999, P = 0.042), but HR < 1 indicated that risk decreased with increasing score. This occurred because patients with intermediately abnormal SPECT studies had a higher likelihood of ArEs compared to patients with extensive abnormalities.The presumption of a monotonic increase in ArE risk with increasing summed I-123-mIBG SPECT score may not be correct as ischemic HF patients with abnormalities of intermediate extent appear at highest risk.