Regional Cardiac Sympathetic Nervous System Evaluation Using 123I-mIBG SPECT in Patients with Heart Failure
Regional Cardiac Sympathetic Nervous System Evaluation Using 123I-mIBG SPECT in Patients with Heart Failure
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DOI：
10.1016/j.jmir.2018.05.001
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发表时间：
2018-12-01
影响因子：
1.8
通讯作者：
Kiat, Hosen
中科院分区：
文献类型：
--
作者：
Iqbal, Basit;Currie, Geoff;Kiat, Hosen
背景：心力衰竭（HF）涉及机械和自主神经系统功能障碍，可导致心源性猝死。在衰竭的人类心脏中，神经元释放的去甲肾上腺素增加，而摄取减少。碘 123 标记的间碘苄基胍 (123I-mIBG) 表明整体摄取量减少和清除增加与心力衰竭死亡率增加相关。本研究探讨了单光子发射计算机断层扫描 (SPECT) 区域定量在心力衰竭患者风险分层中的潜在益处及其在预测心脏发病率和死亡率中的作用。方法：本研究招募了 22 名临床诊断的心力衰竭患者。受试者接受心肌灌注 SPECT 和 123I-mIBG 心脏交感神经成像。早期（注射后 15 分钟）和延迟（注射后 4 小时）进行平面和 SPECT。进行了视觉和半定量分析，并确定了全局（来自平面成像）和区域（来自 SPECT 成像）摄取和洗脱指数。对患者进行长达两年的临床随访，记录这些患者的心脏事件 (CE) 并将其与各种参数相关联。结果：心力衰竭中 CE 的发生与患者的人口统计数据或心力衰竭的原因无关。遗传生物标志物无法可靠地预测 CE。整体或区域吸收预测 CE 的能力有限，而下壁的区域冲刷 (P = .005) 是 CE 的统计显着预测因子。同样，心肌灌注闪烁扫描中梗塞周围和非梗塞节段的 40% 或更高的高冲洗率也是 CE 的重要预测因素 (P = .035)。 结论：心力衰竭是一种复杂、多因素、进行性疾病，似乎是从区域开始的。 123I-mIBG 为心脏的整体和区域交感神经系统神经支配成像提供了宝贵的工具。这可能有助于对有心源性猝死风险的患者进行早期识别和分层。
Background: Heart failure (HF) involves both mechanical and autonomic nervous system dysfunction that can lead to sudden cardiac death. In the failing human heart, there is increased release of norepinephrine from neurons and reduced uptake. Iodine-123-labeled metaiodobenzyl-guanidine (123I-mIBG) demonstrates reduced global uptake and increased washout associated with increased mortality in HF. This research examined the potential benefits of single-photon emission computed tomography (SPECT) regional quantitation in risk stratification of HF patients and its role in prediction of cardiac morbidity and mortality.Methods: Twenty-two clinically diagnosed HF patients were recruited into this study. The subjects underwent myocardial perfusion SPECT and cardiac sympathetic imaging with 123I-mIBG. Early (at 15 min after injection) and delayed (four hours after injection) planar and SPECT were performed. Visual and semiquantitative analysis was conducted, and global (from planar imaging) and regional (from SPECT imaging) uptake and washout indices determined. The patients were clinically followed for up to two years, and the cardiac events (CEs) in these patients were recorded and correlated with the various parameters.Results: The occurrence of a CE in HF was independent of the patients' demographics or the cause of HF. Genetic biomarkers were unable to reliably predict CEs. Global or regional uptake had limited ability to predict a CE, whereas regional washout from the inferior wall (P = .005) was a statistically significant predictor of CEs. Similarly, a high washout of 40% or more from the peri-infarcted and noninfarcted segments on myocardial perfusion scintigraphy was also a significant predictor of CEs (P = .035).Conclusion: HF is a complex, multifactorial, progressive disease that appears to begin regionally. 123I-mIBG provides a valuable tool in imaging the global and regional sympathetic nervous system innervation of the heart. This may allow early identification and stratification of patients at risk of sudden cardiac death.