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Teresińska A, Fronczak-Jakubczyk A, Woźniak O, Maciąg A, Jezierski J, Cicha-Mikołajczyk A, Hoffman P, Biernacka EK. The Utility of Baseline Characteristics and [ 123I]MIBG Cardiac Adrenergic System Scintigraphy in Qualifying Patients with Post-Infarction Heart Failure for Implantable Cardioverter-Defibrillator (ICD) Placement. J Clin Med 2024; 13:6378. [PMID: 39518517 PMCID: PMC11546305 DOI: 10.3390/jcm13216378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 10/21/2024] [Accepted: 10/21/2024] [Indexed: 11/16/2024] Open
Abstract
Background: Post-infarction heart failure with reduced ejection fraction (HFrEF) patients often face persistent risks of sudden cardiac arrest leading to sudden cardiac death. While implanting a cardioverter-defibrillator (ICD) can enhance prognosis, complications and costs limit its widespread use. Current patient qualification criteria, relying on imperfect parameters, require refinement. The impairment of the cardiac adrenergic system in heart failure is associated with ventricular arrhythmias. The goal of the study was to assess the utility of cardiac adrenergic system scintigraphy in qualifying patients for ICD placement. Methods: In this prospective study of 85 post-infarction HFrEF patients at a single center, clinical assessments, laboratory tests, echocardiography, [123I]MIBG scintigraphy, and ICD implantation were performed. Scintigraphy involved planar chest images and evaluating the heart-to-mediastinum ratio (H/M) and washout rate (WO). SPECT imaging assessed [123I]MIBG uptake in 17 left ventricular segments to calculate the summed difference score (SDS). Results: During a median of 4-year follow-up, 22% of patients experienced appropriate ICD interventions, and 25% of patients died or underwent heart transplantation. The mean values of analyzed parameters did not significantly differ between groups. In the univariate analysis, younger age and moderately impaired left ventricular ejection fraction (LVEF) were correlated with more frequent ICD interventions. In comparison, older age and elevated NT-proBNP levels were associated with death or heart transplantation. Additionally, the univariate analysis identified SDS-15' as a prognostic factor for death/heart transplant. The multivariate analysis identified predictors for ICD interventions, including younger age, an EF of 30% or greater, and a larger left ventricular end-diastolic diameter. In contrast, older age and an LVEF of less than 25% were significant predictors of death or heart transplantation. Conclusions: Scintigraphic parameters did not effectively predict ICD interventions or death/heart transplantation, though the summed difference score demonstrated potential as a prognostic factor. Younger age with moderately impaired EF correlated with frequent ICD interventions, while in older age, EF < 25% predicted death or transplantation. Further investigation is needed for patients with borderline EF values.
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Affiliation(s)
- Anna Teresińska
- Department of Nuclear Medicine, Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Aneta Fronczak-Jakubczyk
- Department of Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland; (A.F.-J.); (J.J.)
| | - Olgierd Woźniak
- Department of Congenital Heart Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Aleksander Maciąg
- Department of Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland; (A.F.-J.); (J.J.)
| | - Jarosław Jezierski
- Department of Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland; (A.F.-J.); (J.J.)
| | - Alicja Cicha-Mikołajczyk
- Department of Epidemiology, Cardiovascular Diseases Prevention and Health Promotion, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Piotr Hoffman
- Department of Congenital Heart Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland
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Hagen JM, Zacherl MJ, Brendel M, Clauß S, Kääb S, Bartenstein P, Todica A, Böning G, Fischer M. Quantitative assessment of cardiac 123iodo-metaiodobenzylguanidine SPECT/CT in patients with arrhythmogenic right ventricular cardiomyopathy: Novel insight in disease monitoring. J Nucl Cardiol 2024; 39:101911. [PMID: 39009215 DOI: 10.1016/j.nuclcard.2024.101911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/24/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND The heart-to-mediastinum ratio (H/M-Ratio) of 123iodo-metaiodobenzylguanidine (123I-MIBG) represents state-of-the-art assessment for sympathetic dysfunction in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aims to evaluate quantitative reconstruction of 123I-MIBG uptake and to demonstrate its correlation with echocardiographic parameters. METHODS Cardiac innervation was assessed in 23 patients diagnosed with definite ARVC or borderline ARVC and 12 patients with other cardiac disease presenting arrhythmia, using quantitative 123I-MIBG Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) imaging. Tracer uptake was evaluated in the left (LV) and right ventricle (RV) based on a CT scan after quantitative image reconstruction. The relationship between tracer uptake and echocardiographic parameter data was examined. RESULTS Absolute quantification of 123I-MIBG uptake in the LV and RV is feasible and correlates accurately with the gold standard H/M Ratio. When comparing sensitivity and specificity, the area under the curve (AUC) favors standardized uptake value (SUV) of the RV over the right-ventricle-to-mediastinum-ratio (RV/M-Ratio) for diagnosing ARVC. A reduced RV-SUV in patients with definite ARVC is associated with reduced RV function. RV polar maps revealed globally reduced 123I-MIBG uptake without segment-specific reduction in the RV. CONCLUSIONS Quantitative 123I-MIBG SPECT in ARCV patients offers robust potential for clinical reporting and demonstrates a significant correlation with RV function. Segmental RV analysis needs to be evaluated in larger samples. In summary, cardiac 123I-MIBG imaging using SUV could facilitate image-guided therapy in patients diagnosed with ARVC.
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Affiliation(s)
- Johannes M Hagen
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich 81377, Germany
| | - Mathias J Zacherl
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich 81377, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich 81377, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Sebastian Clauß
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistrasse 15, 81377 Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany; Institute of Surgical Research at the Walter-Brendel-Center of Experimental Medicine, University Hospital, LMU Munich, Marchioninistrasse 27, D-81377 Munich, Germany; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), the Netherlands; Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Munich, Germany
| | - Stefan Kääb
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistrasse 15, 81377 Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany; Institute of Surgical Research at the Walter-Brendel-Center of Experimental Medicine, University Hospital, LMU Munich, Marchioninistrasse 27, D-81377 Munich, Germany; Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), the Netherlands; Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich 81377, Germany
| | - Andrei Todica
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich 81377, Germany
| | - Guido Böning
- Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich 81377, Germany
| | - Maximilian Fischer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistrasse 15, 81377 Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
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3
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Gadioli LP, Schmidt A, Maciel BC, Volpe GJ, Simões MV, Marin-Neto JA. Chagas Cardiomyopathy and Myocardial Sympathetic Denervation. Curr Cardiol Rep 2024; 26:635-641. [PMID: 38656586 DOI: 10.1007/s11886-024-02057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW More than a century since its discovery, the pathogenesis of Chagas heart disease (CHD) remains incompletely understood. The role of derangements in the autonomic control of the heart in triggering malignant arrhythmia before the appearance of contractile ventricular impairment was reviewed. RECENT FINDINGS Although previous investigations had demonstrated the anatomical and functional consequences of parasympathetic dysautonomia upon the heart rate control, only recently, coronary microvascular disturbances and sympathetic denervation at the ventricular level have been reported in patients and experimental models of CHD, exploring with nuclear medicine methods their impact on the progression of myocardial dysfunction and cardiac arrhythmias. More important than parasympathetic impaired sinus node regulation, recent evidence indicates that myocardial sympathetic denervation associated with coronary microvascular derangements is causally related to myocardial injury and arrhythmia in CHD. Additionally, 123I-MIBG imaging is a promising tool for risk stratification of progression of ventricular dysfunction and sudden death.
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Affiliation(s)
- Leonardo Pippa Gadioli
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - André Schmidt
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Benedito Carlos Maciel
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Gustavo Jardim Volpe
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcus Vinicius Simões
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - José Antonio Marin-Neto
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
- Interventional Cardiology Unit, Division of Cardiology, Medical School of Ribeirao Preto, University of Sao Paulo, Campus Universitário, Bairro Monte Alegre, S/N-Ribeirão Preto, Estado de São Paulo, CEP, 14048-900, Brazil.
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Okuda K, Nakajima K, Kitamura C, Ljungberg M, Hosoya T, Kirihara Y, Hashimoto M. Machine learning-based prediction of conversion coefficients for I-123 metaiodobenzylguanidine heart-to-mediastinum ratio. J Nucl Cardiol 2023; 30:1630-1641. [PMID: 36740650 PMCID: PMC10372132 DOI: 10.1007/s12350-023-03198-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/22/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE We developed a method of standardizing the heart-to-mediastinal ratio in 123I-labeled meta-iodobenzylguanidine (MIBG) images using a conversion coefficient derived from a dedicated phantom. This study aimed to create a machine-learning (ML) model to estimate conversion coefficients without using a phantom. METHODS 210 Monte Carlo (MC) simulations of 123I-MIBG images to obtain conversion coefficients using collimators that differed in terms of hole diameter, septal thickness, and length. Simulated conversion coefficients and collimator parameters were prepared as training datasets, then a gradient-boosting ML was trained to estimate conversion coefficients from collimator parameters. Conversion coefficients derived by ML were compared with those that were MC simulated and experimentally derived from 613 phantom images. RESULTS Conversion coefficients were superior when estimated by ML compared with the classical multiple linear regression model (root mean square deviations: 0.021 and 0.059, respectively). The experimental, MC simulated, and ML-estimated conversion coefficients agreed, being, respectively, 0.54, 0.55, and 0.55 for the low-; 0.74, 0.70, and 0.72 for the low-middle; and 0.88, 0.88, and 0.88 for the medium-energy collimators. CONCLUSIONS The ML model estimated conversion coefficients without the need for phantom experiments. This means that conversion coefficients were comparable when estimated based on collimator parameters and on experiments.
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Affiliation(s)
- Koichi Okuda
- Department of Physics, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
- Department of Radiation Science, Hirosaki University Graduate School of Health Sciences, Hirosaki-shi, Aomori, Japan.
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | | | | | | | | | - Mitsumasa Hashimoto
- Department of Physics, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
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Assante R, D'Antonio A, Mannarino T, Nappi C, Gaudieri V, Zampella E, Buongiorno P, Cantoni V, Green R, Frega N, Verberne HJ, Petretta M, Cuocolo A, Acampa W. Simultaneous assessment of myocardial perfusion and adrenergic innervation in patients with heart failure by low-dose dual-isotope CZT SPECT imaging. J Nucl Cardiol 2022; 29:3341-3351. [PMID: 35378694 PMCID: PMC9834348 DOI: 10.1007/s12350-022-02951-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/06/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND In patients with heart failure (HF) sequential imaging studies have demonstrated a relationship between myocardial perfusion and adrenergic innervation. We evaluated the feasibility of a simultaneous low-dose dual-isotope 123I/99mTc-acquisition protocol using a cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) camera. METHODS AND RESULTS Thirty-six patients with HF underwent simultaneous low-dose 123I-metaiodobenzylguanidine (MIBG)/99mTc-sestamibi gated CZT-SPECT cardiac imaging. Perfusion and innervation total defect sizes and perfusion/innervation mismatch size (defined by 123I-MIBG defect size minus 99mTc-sestamibi defect size) were expressed as percentages of the total left ventricular (LV) surface area. LV ejection fraction (EF) significantly correlated with perfusion defect size (P < .005), innervation defect size (P < .005), and early (P < .05) and late (P < .01) 123I-MIBG heart-to-mediastinum (H/M) ratio. In addition, late H/M ratio was independently associated with reduced LVEF (P < .05). Although there was a significant relationship (P < .001) between perfusion and innervation defect size, innervation defect size was larger than perfusion defect size (P < .001). At multivariable linear regression analysis, 123I-MIBG washout rate (WR) correlated with perfusion/innervation mismatch (P < .05). CONCLUSIONS In patients with HF, a simultaneous low-dose dual-isotope 123I/99mTc-acquisition protocol is feasible and could have important clinical implications.
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Affiliation(s)
- Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Pietro Buongiorno
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Nicola Frega
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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Mehta PK, Huang J, Levit RD, Malas W, Waheed N, Bairey Merz CN. Ischemia and no obstructive coronary arteries (INOCA): A narrative review. Atherosclerosis 2022; 363:8-21. [PMID: 36423427 PMCID: PMC9840845 DOI: 10.1016/j.atherosclerosis.2022.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/30/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
Myocardial ischemia with no obstructive coronary arteries (INOCA) is a chronic coronary syndrome condition that is increasingly being recognized as a substantial contributor to adverse cardiovascular mortality and outcomes, including myocardial infarction and heart failure with preserved ejection fraction (HFpEF). While INOCA occurs in both women and men, women are more likely to have the finding of INOCA and are more adversely impacted by angina, with recurrent hospitalizations and a lower quality of life with this condition. Abnormal epicardial coronary vascular function and coronary microvascular dysfunction (CMD) have been identified in a majority of INOCA patients on invasive coronary function testing. CMD can co-exist with obstructive epicardial coronary artery disease (CAD), diffuse non-obstructive epicardial CAD, and with coronary vasospasm. Epicardial vasospasm can also occur with normal coronary arteries that have no atherosclerotic plaque on intravascular imaging. While all predisposing factors are not clearly understood, cardiometabolic risk factors, and endothelium dependent and independent mechanisms that increase oxidative stress and inflammation are associated with microvascular injury, CMD and INOCA. Cardiac autonomic dysfunction has also been implicated in abnormal vasoreactivity and persistent symptoms. INOCA is under-recognized and under-diagnosed, partly due to the heterogenous patient populations and mechanisms. However, diagnostic testing methods are available to guide INOCA management. Treatment of INOCA is evolving, and focuses on cardiac risk factor control, improving ischemia, reducing atherosclerosis progression, and improving angina and quality of life. This review focuses on INOCA, relations to HFpEF, available diagnostics, current and investigational therapeutic strategies, and knowledge gaps in this condition.
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Affiliation(s)
- Puja K Mehta
- Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Jingwen Huang
- J. Willis Hurst Internal Medicine Residency Training Program, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca D Levit
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Waddah Malas
- Cardiovascular Disease Fellowship Training Program, Loyola Medical Center, Chicago, IL, USA
| | - Nida Waheed
- Cardiovascular Disease Fellowship Training Program, Emory University School of Medicine, Atlanta, GA, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
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Bandyopadhyay D, Gerard P, Jain D. Significance of 123I-mIBG SPECT cardiac imaging in heart failure. J Nucl Cardiol 2022; 29:1810-1812. [PMID: 33948895 DOI: 10.1007/s12350-021-02643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Dhrubajyoti Bandyopadhyay
- Department of Cardiovascular Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Perry Gerard
- Department of Radiology, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA
| | - Diwakar Jain
- Department of Cardiovascular Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
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Verschure DO, Nakajima K, Verberne HJ. Cardiac 123I- mIBG Imaging in Heart Failure. Pharmaceuticals (Basel) 2022; 15:656. [PMID: 35745574 PMCID: PMC9230638 DOI: 10.3390/ph15060656] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 12/10/2022] Open
Abstract
Cardiac sympathetic upregulation is one of the neurohormonal compensation mechanisms that play an important role in the pathogenesis of chronic heart failure (CHF). In the past decades, cardiac 123I-mIBG scintigraphy has been established as a feasible technique to evaluate the global and regional cardiac sympathetic innervation. Although cardiac 123I-mIBG imaging has been studied in many cardiac and neurological diseases, it has extensively been studied in ischemic and non-ischemic CHF. Therefore, this review will focus on the role of 123I-mIBG imaging in CHF. This non-invasive, widely available technique has been established to evaluate the prognosis in CHF. Standardization, especially among various combinations of gamma camera and collimator, is important for identifying appropriate thresholds for adequate risk stratification. Interestingly, in contrast to the linear relationship between 123I-mIBG-derived parameters and overall prognosis, there seems to be a "bell-shape" curve for 123I-mIBG-derived parameters in relation to ventricular arrhythmia or appropriate implantable cardioverter defibrillator (ICD) therapy in patients with ischemic CHF. In addition, there is a potential clinical role for cardiac 123I-mIBG imaging in optimizing patient selection for implantation of expensive devices such as ICD and cardiac resynchronization therapy (CRT). Based on cardiac 123I-mIBG data risk models and machine learning, models have been developed for appropriate risk assessment in CHF.
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Affiliation(s)
- Derk O. Verschure
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location Amsterdam Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Department of Cardiology, Zaans Medical Center, Koningin Julianaplein 58, 1502 DV Zaandam, The Netherlands
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa 920-8641, Japan;
| | - Hein J. Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location Amsterdam Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
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9
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Sazonova SI, Atabekov TA, Batalov RE, Mishkina AI, Varlamova JV, Zavadovsky KV, Popov SV. Prediction of appropriate ICD therapy in patients with ischemic heart failure. J Nucl Cardiol 2022; 29:680-691. [PMID: 32851586 DOI: 10.1007/s12350-020-02321-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Previous studies show inconsistent results on the role of innervation imaging (with I-123-mIBG) and perfusion imaging in predicting appropriate ICD therapy (aICDth). These studies included patients with both dilated and ischemic cardiomyopathy. This study compared the ability of 123I-mIBG imaging along with perfusion imaging (using thallium-199) to predict aICDth in patients with ischemic heart failure (IHF) in relation to indication for ICD implantation (primary vs. secondary prevention of sudden cardiac death (SCD)). METHODS mIBG/thallium SPECT imaging were performed before ICD implantation in 80 patients with IHF: 49 candidates for primary and 31 for secondary SCD prevention. RESULTS During a mean follow-up of 18 months, the imaging results could not predict patients with appropriate ICD therapy among patients with ICD implants for primary SCD prevention. While in the secondary SCD prevention group, those who received a ICDth had significantly larger summed scores of regional perfusion and innervation impairment, but not higher heart-to-mediastinal mIBG ratio. The best results to predict aICDth were using mIBG summed score (cut-off point > 34%, sensitivity 72%, specificity 100%, AUC 0.909, P < 0.0001). CONCLUSION The prognostic value of innervation and perfusion imaging in patients with IHF differ based on indication for ICD implantation (primary vs. secondary prevention of SCD).
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Affiliation(s)
- Svetlana I Sazonova
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russian Federation.
| | - Tariel A Atabekov
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russian Federation
| | - Roman E Batalov
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russian Federation
| | - Anna I Mishkina
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russian Federation
| | - Julia V Varlamova
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russian Federation
| | - Konstantin V Zavadovsky
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russian Federation
| | - Sergey V Popov
- Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russian Federation
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10
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Nakajima K, Nakata T, Doi T, Tada H, Maruyama K. Machine learning-based risk model using 123I-metaiodobenzylguanidine to differentially predict modes of cardiac death in heart failure. J Nucl Cardiol 2022; 29:190-201. [PMID: 32410060 PMCID: PMC8873155 DOI: 10.1007/s12350-020-02173-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac sympathetic dysfunction is closely associated with cardiac mortality in patients with chronic heart failure (CHF). We analyzed the ability of machine learning incorporating 123I-metaiodobenzylguanidine (MIBG) to differentially predict risk of life-threatening arrhythmic events (ArE) and heart failure death (HFD). METHODS AND RESULTS A model was created based on patients with documented 2-year outcomes of CHF (n = 526; age, 66 ± 14 years). Classifiers were trained using 13 variables including age, gender, NYHA functional class, left ventricular ejection fraction and planar 123I-MIBG heart-to-mediastinum ratio (HMR). ArE comprised arrhythmic death and appropriate therapy with an implantable cardioverter defibrillator. The probability of ArE and HFD at 2 years was separately calculated based on appropriate classifiers. The probability of HFD significantly increased as HMR decreased when any variables were combined. However, the probability of arrhythmic events was maximal when HMR was intermediate (1.5-2.0 for patients with NYHA class III). Actual rates of ArE were 3% (10/379) and 18% (27/147) in patients at low- (≤ 11%) and high- (> 11%) risk of developing ArE (P < .0001), respectively, whereas those of HFD were 2% (6/328) and 49% (98/198) in patients at low-(≤ 15%) and high-(> 15%) risk of HFD (P < .0001). CONCLUSION A risk model based on machine learning using clinical variables and 123I-MIBG differentially predicted ArE and HFD as causes of cardiac death.
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Affiliation(s)
- Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8640, Japan.
| | - Tomoaki Nakata
- Department of Cardiology, Hakodate-Goryoukaku Hospital, Hakodate, Japan
| | - Takahiro Doi
- Department of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hayato Tada
- Department of Cardiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Koji Maruyama
- Wolfram Research Inc., Tokyo, Japan
- Department of Chemistry and Materials Science, Osaka City University, Osaka, Japan
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11
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Heart diseases (autonomic dysfunctions)—Myocardial innervation imaging: 123I-MIBG planar scintigraphy and SPECT. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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12
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Nappi C, Assante R, Zampella E, Gaudieri V, De Simini G, Giordano A, D'Antonio A, Acampa W, Petretta M, Cuocolo A. Relationship between heart rate response and cardiac innervation in patients with suspected or known coronary artery disease. J Nucl Cardiol 2021; 28:2676-2683. [PMID: 32166569 DOI: 10.1007/s12350-020-02091-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Chronotropic response to pharmacological stress test is blunted in patients with autonomic neuropathy. The relationship between heart rate (HR) changes during pharmacological stress test and cardiac autonomic dysfunction has not been fully investigated. We assessed the potential interplay between HR response (HRR) and myocardial innervation in patients with suspected or known coronary artery disease (CAD). METHODS AND RESULTS We studied 71 patients with suspected or known CAD referred to pharmacological stress myocardial perfusion imaging and 123I metaiodobenzylguanidine (123I-MIBG) cardiac scintigraphy. HRR was calculated as the maximum percent change from baseline according to the formula: (peak HR - rest HR)/rest HR × 100. 123I-MIBG heart-to-mediastinum (H/M) ratio was calculated and a late H/M ratio < 1.6 was considered abnormal. HRR progressively decreased with decreasing late H/M ratio (P for trend = 0.02) and a significant correlation between HRR and late H/M ratio (P = 0.03) was observed. The addition of HRR to a model including age, diabetes, known CAD, left ventricular ejection fraction, and stress-induced ischemia added incremental value in predicting an abnormal late H/M ratio, increasing the global chi-square from 8.09 to 13.8 (P = 0.02). CONCLUSIONS The relationship between HRR and cardiac sympathetic innervation in patients with suspected or known CAD confirms a strong interplay between cardiac response to stress tests and cardiac autonomic activation. This finding suggests that HRR may be used as a surrogate for assessing cardiac sympathetic function.
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Affiliation(s)
- Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Giovanni De Simini
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Alessia Giordano
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
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13
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Comparison between planar and single-photon computed tomography images for radiation intensity quantification in iodine-131 scintigraphy. Sci Rep 2021; 11:21858. [PMID: 34750482 PMCID: PMC8576011 DOI: 10.1038/s41598-021-01432-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
This study aimed to evaluate the feasibility of quantifying iodine-131 (131I) accumulation in scintigraphy images and compare planar and single-photon emission computed tomography (SPECT) images to estimate 131I radioactivity in patients receiving radioactive iodine therapy for thyroid cancer. We evaluated 72 sets of planar and SPECT images acquired between February 2017 and December 2018. Simultaneously, we placed a reference 131I capsule next to the patient during image acquisition. We evaluated the correlation between the intensity of the capsule in the images and the capsule dose and estimated the radiation dose at the thyroid bed. The mean capsule dose was 2.14 MBq (range, 0.63–4.31 MBq). The correlation coefficients (p-value) between capsule dose and maximum and mean intensities in both planar and SPECT images were 0.93 (p < 0.01), 0.96 (p < 0.01), 0.60 (p < 0.01), and 0.47 (p < 0.01), respectively. The mean intensities of planar images show the highest correlation coefficients. Based on a regression equation, the average radiation dose in the thyroid bed was 5.9 MBq. In conclusion, planar images reflected the radiation dose more accurately than SPECT images. The regression equation allows to determine the dose in other regions, such as the thyroid bed or sites of distant metastasis.
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Cardiac Sympathetic Activity and Rhythm Control Following Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation-A Prospective 123I-mIBG-SPECT/CT Imaging Study. J Pers Med 2021; 11:jpm11100995. [PMID: 34683135 PMCID: PMC8549007 DOI: 10.3390/jpm11100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pulmonary vein isolation (PVI) and antiarrhythmic drug therapy are established treatment strategies to preserve sinus rhythm in atrial fibrillation (AF). However, the efficacy of both interventional and pharmaceutical therapy is still limited. Solid evidence suggests an important role of the cardiac sympathetic nervous system in AF. In this blinded, prospective observational study, we studied left ventricular cardiac sympathetic activity in patients treated with PVI and with antiarrhythmic drugs. Prospectively, Iodine-123-benzyl-guanidine single photon emission computer tomography (123I-mIBG-SPECT) was performed in a total of 23 patients with paroxysmal AF, who underwent PVI (n = 20) or received antiarrhythmic drug therapy only (n = 3), respectively. 123I-mIBG planar and SPECT/CT scans were performed before and 4 to 8 weeks after PVI (or initiation of drug therapy, respectively). For semiquantitative SPECT image analysis, attenuation-corrected early/late images were analyzed. Quantitative SPECT analysis was performed using the AHA 17-segment model of the left ventricle. RESULTS PVI with point-by-point radiofrequency ablation led to a significantly (p < 0.05) higher visual sympathetic innervation defect score when comparing pre-and post PVI. Newly emerging innervation deficits post PVI were localized predominantly in the inferior lateral wall. These findings were corroborated by semiquantitative SPECT analysis identifying inferolateral segments with a reduced tracer uptake in comparison to SPECT before PVI. Following PVI, patients with an AF relapse showed a different sympathetic innervation pattern compared to patients with sufficient rhythm control. CONCLUSIONS PVI results in novel defects of cardiac sympathetic innervation. Differences in cardiac sympathetic innervation remodelling following PVI suggest an important role of the cardiac autonomous nervous system in the maintenance of sinus rhythm following PVI.
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Verschure DO, Nakajima K, Jacobson AF, Verberne HJ. 40 Years Anniversary of Cardiac 123I-mIBG Imaging: State of the Heart. CURRENT CARDIOVASCULAR IMAGING REPORTS 2021. [DOI: 10.1007/s12410-021-09555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of Review
This narrative review reflects on the body of evidence on cardiac 123I-mIBG imaging that has accumulated since the introduction in the late 1970s and focusses on to what extent cardiac 123I-mIBG imaging has fulfilled its potential in cardiology especially.
Recent Findings
In contrast to the linear relationship between 123I-mIBG-derived parameters and overall prognosis in heart failure, there seems a “bell-shape” curve for 123I-mIBG-derived parameters and arrhythmic events. In addition, there is a potential clinical role for cardiac 123I-mIBG in optimizing patient selection for expensive devices (i.e., ICD and CRT). This needs of course to be established in future trials.
Summary
Cardiac 123I-mIBG imaging is, despite the numerous of studies, sometimes mistakenly seen as a nice to have technique rather than a must have imaging modality. Although cardiac 123I-mIBG imaging has grown and matured over the years, its full clinical potential has still not been tested to the maximum.
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16
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Gimelli A, Liga R, Agostini D, Bengel FM, Ernst S, Hyafil F, Saraste A, Scholte AJHA, Verberne HJ, Verschure DO, Slart RHJA. The role of myocardial innervation imaging in different clinical scenarios: an expert document of the European Association of Cardiovascular Imaging and Cardiovascular Committee of the European Association of Nuclear Medicine. Eur Heart J Cardiovasc Imaging 2021; 22:480-490. [PMID: 33523108 DOI: 10.1093/ehjci/jeab007] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/08/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiac sympathetic activity plays a key role in supporting cardiac function in both health and disease conditions, and nuclear cardiac imaging has always represented the only way for the non-invasive evaluation of the functional integrity of cardiac sympathetic terminals, mainly through the use of radiopharmaceuticals that are analogues of norepinephrine and, in particular, with the use of 123I-mIBG imaging. This technique demonstrates the presence of cardiac sympathetic dysfunction in different cardiac pathologies, linking the severity of sympathetic nervous system impairment to adverse patient's prognosis. This article will outline the state-of-the-art of cardiac 123I-mIBG imaging and define the value and clinical applications in the different fields of cardiovascular diseases.
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Affiliation(s)
- Alessia Gimelli
- Department of Imaging, Fondazione Toscana/CNR Gabriele Monasterio1, via Moruzzi n.1, Pisa 56124, Italy
| | - Riccardo Liga
- Cardiac-Thoracic-Vascular Department, Università di Pisa, Pisa, Italy
| | - Denis Agostini
- Department of Nuclear Medicine, University Hospital of Normandy, CHU Cote de Nacre, Caen, France
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, UK
| | - Fabien Hyafil
- Department of Nuclear Medicine, European Hospital Georges-Pompidou, DMU IMAGINA, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris, France
| | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland.,Heart Center, Turku University Hospital, Turku, Finland
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Derk O Verschure
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, Zaans Medical Center, Zaandam, the Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Centre, University Medical Center Groningen, Groningen, The Netherlands.,Faculty of Science and Technology, Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
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Verberne HJ, Verschure DO. How to best appreciate the possible clinical role of cardiac 123I-mIBG scintigraphy in heart failure patients: Trying not to get lost while going in the right direction! J Nucl Cardiol 2021; 28:1504-1506. [PMID: 31538324 DOI: 10.1007/s12350-019-01895-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Affiliation(s)
- H J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - D O Verschure
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Cardiology, Zaans Medical Center, Zaandam, The Netherlands
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18
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Nakajima K, Okuda K, Komatsu J. What does diagnostic threshold mean? Deterministic and probabilistic considerations. J Nucl Cardiol 2021; 28:1702-1706. [PMID: 31549288 DOI: 10.1007/s12350-019-01899-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8640, Japan.
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Kahoku, Japan
| | - Junji Komatsu
- Department of Neurology, Kanazawa University Hospital, Kanazawa, Japan
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Brito AXD, Glavam A, Bronchtein AI, Rosado-de-Castro PH. Autonomic Innervation Evaluation in Cardiac Disease. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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20
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Sunaga A, Hikoso S, Yamada T, Yasumura Y, Uematsu M, Abe H, Nakagawa Y, Higuchi Y, Fuji H, Mano T, Kurakami H, Yamada T, Kitamura T, Sato T, Oeun B, Kida H, Kojima T, Sotomi Y, Dohi T, Okada K, Suna S, Mizuno H, Nakatani D, Sakata Y. Abdominal obesity, and not general obesity, is associated with a lower 123I MIBG heart-to-mediastinum ratio in heart failure patients with preserved ejection fraction. Eur J Nucl Med Mol Imaging 2021; 49:609-618. [PMID: 33715034 DOI: 10.1007/s00259-021-05280-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/23/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The relationship between general obesity or abdominal obesity (abdominal circumference of ≥85 cm in men and ≥ 90 cm in women) and the heart-to-mediastinum ratio (HMR), a measure of cardiac sympathetic innervation, on cardiac iodine-123-metaiodobenzylguanidine scintigraphy (MIBG) in patients with heart failure with preserved ejection fraction (HFpEF) has not been clarified. METHODS A total of 239 HFpEF patients with both MIBG and abdominal circumference data were examined. We divided these patients into those with abdominal obesity and those without it. In the cardiac MIBG study, early phase image was acquired 15-20 min after injection, and late phase image was acquired 3 h after the early phase. A HMR obtained from a low-energy type collimator was converted to that obtained by a medium-energy type collimator. RESULTS Early and late HMRs were significantly lower in those with abdominal obesity, although washout rates were not significantly different. The incidence of patients with early and late HMRs <2.2 was significantly higher in those with abdominal obesity. Multivariate linear regression analysis revealed that abdominal obesity was independently associated with early HMR (standardized β = -0.253, P = 0.003) and late HMR (standardized β = -0.222, P = 0.010). Multivariate logistic regression analysis revealed that abdominal obesity was independently associated with early (odds ratio [OR] [95% confidence interval {CI}] = 4.25 [2.13, 8.47], P < 0.001) and late HMR < 2.2 (OR [95% CI] = 2.06 [1.11, 3.83], P = 0.022). Elevated BMI was not significantly associated with low early and late HMR. The presence of abdominal obesity was significantly associated with low early and late HMR even in patients without elevated BMI values. CONCLUSION Abdominal obesity, but not general obesity, in HFpEF patients was independently associated with low HMR, suggesting that visceral fat may contribute to decreased cardiac sympathetic activity in patients with HFpEF. TRIAL REGISTRATION UMIN000021831.
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Affiliation(s)
- Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan.
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, 3-1-56 Mandaihigashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Yoshio Yasumura
- Division of Cardiology, Amagasaki Chuo Hospital, 1-12-1 Sioe, Amagasaki, Hyogo, 660-0892, Japan
| | - Masaaki Uematsu
- Division of Cardiology, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Haruhiko Abe
- Division of Cardiology, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan
| | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Hospital, 5-21-1, Kawanishi, Hyogo, 666-0195, Japan
| | - Yoshiharu Higuchi
- Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayamacho, Tennojiku, Osaka, 543-0035, Japan
| | - Hisakazu Fuji
- Division of Cardiology, Kobe Ekisaikai Hospital, 1-21-1 Manabigaoka, Tarumi-ku, Kobe, 655-0004, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan
| | - Hiroyuki Kurakami
- Department of Medical Innovation, Osaka University Hospital, Suita, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital, Suita, 2-15 Yamadaoka, Suita, 565-0871, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Taiki Sato
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Bolrathanak Oeun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Takayuki Kojima
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Shinichiro Suna
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Hiroya Mizuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan
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Giovanni S, Stefano M, Teresa SM, Margherita C, Giovanni B, Umberto P, Paola P, Giacomo C, Pierfranco D, Alfonso G, Riccardo C, Claudio M. Incremental prognostic value of myocardial neuroadrenergic damage in patients with chronic congestive heart failure: An iodine-123 meta-iodobenzylguanidine scintigraphy study. J Nucl Cardiol 2020; 27:1787-1797. [PMID: 30377997 DOI: 10.1007/s12350-018-01467-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 09/17/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND ICD in primary prevention reduced mortality in patients with heart failure (HF); however, in about 80% of the ICD recipients an event requiring a device intervention will never occur. Thus, a reliable screening test included in a multiparametric approach to appropriately select patients to ICD implantation is increasingly required. Aim of the work was to assess if the Iodine-123 Meta-Iodobenzylguanidine scintigraphy (123I-mIBG) could be useful to identify patients with HF who would not benefit from the ICD implantation because at low risk of arrhythmias. METHODS AND RESULTS This is a retrospective multicentre study on patients undergoing 123I-mIBG from February 2012 to December 2015. Inclusion criteria where: age ≥ 18 years old, LVEF ≤ 35% with idiopathic or ischemic heart disease, no previous malignant ventricular arrhythmias. Patients were divided in two groups based on of late H/M < or ≥ 1.60 on 123I-mIBG. Primary end-point was occurrence of malignant arrhythmias. Secondary end-point was occurrence of cardiac death and hospitalization for worsening HF. MACE were mortality and malignant arrhythmias. Eighty-one patients were enrolled (mean age: 69 years). On 123I-mIBG, 54 patients had late H/M < 1.6 and 27 patients had late H/M ≥ 1.60. After a mean follow-up of 13.3 (± 9.7) months, the primary end-point occurred in 13 patients out of 81. No arrhythmias occurred in patients with H/M late ≥ 1.6. Nineteen patients out of 20 with MACE showed an H/M late < 1.6. Death in group with H/M ≥ 1.6 occurred for worsening HF. A late H/M ≥ 1.60 showed a very high NPV for arrhythmia (100%) and for death (96.3%). CONCLUSION 123I-mIBG imaging has the capability to identify patients at low risk of events.
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Affiliation(s)
- Scrima Giovanni
- Cardiology Department, Ospedale Santa Croce Moncalieri, Moncalieri, Italy.
| | - Maffè Stefano
- Division of Cardiology, SS Trinita' Hospital, ASL No, Borgomanero, NO, Italy
| | | | | | - Bertuccio Giovanni
- Nuclear Medicine Department, Ospedale Santa Croce Moncalieri, Moncalieri, Italy
| | - Parravicini Umberto
- Division of Cardiology, SS Trinita' Hospital, ASL No, Borgomanero, NO, Italy
| | - Paffoni Paola
- Division of Cardiology, SS Trinita' Hospital, ASL No, Borgomanero, NO, Italy
| | - Canavese Giacomo
- Nuclear Medicine Department, Ospedale Santa Croce Moncalieri, Moncalieri, Italy
| | | | - Gambino Alfonso
- Cardiology Department, Ospedale Santa Croce Moncalieri, Moncalieri, Italy
| | - Campini Riccardo
- IRCCS Nuclear Medicine Department, Maugeri Clinical Scientific Institute, Veruno, Italy
| | - Marcassa Claudio
- IRCCS Cardiology Department, Maugeri Clinical Scientific Institute, Veruno, Italy
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22
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Laursen AH, Ripa RS, Hasbak P, Kjær A, Elming MB, Køber L, Hutchings M, Thune JJ. 123I-MIBG for detection of subacute doxorubicin-induced cardiotoxicity in patients with malignant lymphoma. J Nucl Cardiol 2020; 27:931-939. [PMID: 30569409 DOI: 10.1007/s12350-018-01566-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Doxorubicin is the mainstay of curative lymphoma treatment but is associated with a dose-dependent cardiotoxicity that is often recognized too late to avoid substantial irreversible cardiac injury. Iodine-123 metaiodobenzylguanidine (123I-MIBG) is a gamma-emitting tracer that mimics noradrenaline uptake, storage, and release mechanisms in adrenergic presynaptic neurons. 123I-MIBG scintigraphy can be used for assessment of doxorubicin-induced injury to myocardial adrenergic neurons during treatment and could be the tool for early detection of doxorubicin cardiotoxicity, which is currently lacking. METHODS AND RESULTS A total of 37 lymphoma patients scheduled for doxorubicin treatment were included in our study. 123I-MIBG imaging was performed prior to chemotherapy and after a median of 4 cycles of doxorubicin. Early and late heart-to-mediastinum ratios (H/Mearly and H/Mlate) and washout rate (WOR) were used for evaluation of cardiotoxicity. The prognostic value of 123I-MIBG results was assessed using left ventricular ejection fraction (LVEF) as measured by cardiac magnetic resonance at 1-year follow-up. We found a post-therapy increase in WOR (including nine patients with > 10% increase), which was not statistically significant (18.6 vs 23.4%, P = 0.09). The difference appeared to be driven by an increase in H/Mearly. LVEF decreased from baseline to 1-year follow-up (64 vs 58%, P = 0.03). LVEF change was not associated with changes in WOR (P = 0.5). CONCLUSION The present study does not provide evidence for 123I-MIBG imaging as a clinically applicable tool for early detection of doxorubicin-induced cardiotoxicity.
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Affiliation(s)
- Adam Høgsbro Laursen
- Department of Hematology, Rigshospitalet, University of Copenhagen, section 9322, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Rasmus Sejersten Ripa
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Marie Bayer Elming
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Martin Hutchings
- Department of Hematology, Rigshospitalet, University of Copenhagen, section 9322, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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23
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AlJaroudi W. Heart rate and 123I-MIBG in heart failure with preserved ejection fraction: More variability and slower washout-A secret recipe for better survival. J Nucl Cardiol 2020; 27:843-848. [PMID: 30414060 DOI: 10.1007/s12350-018-01514-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Wael AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon.
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Wan N, Travin MI. Cardiac Imaging With 123I-meta-iodobenzylguanidine and Analogous PET Tracers: Current Status and Future Perspectives. Semin Nucl Med 2020; 50:331-348. [PMID: 32540030 DOI: 10.1053/j.semnuclmed.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Autonomic innervation plays an important role in proper functioning of the cardiovascular system. Altered cardiac sympathetic function is present in a variety of diseases, and can be assessed with radionuclide imaging using sympathetic neurotransmitter analogues. The most studied adrenergic radiotracer is cardiac 123I-meta-iodobenzylguanidine (123I-mIBG). Cardiac 123I-mIBG uptake can be evaluated using both planar and tomographic imaging, thereby providing insight into global and regional sympathetic innervation. Standardly assessed imaging parameters are the heart-to-mediastinum ratio and washout rate, customarily derived from planar images. Focal tracer deficits on tomographic imaging also show prognostic utility, with some data suggesting that the best approach to tomographic image interpretation may differ from conventional methods. Cardiac 123I-mIBG image findings strongly correlate with the severity and prognosis of many cardiovascular diseases, especially heart failure and ventricular arrhythmias. Cardiac 123I-mIBG imaging in heart failure is FDA approved for prognostic purposes. With the robustly demonstrated ability to predict occurrence of potentially fatal arrhythmias, cardiac 123I-mIBG imaging shows promise for better selecting patients who will benefit from an implantable cardioverter defibrillator, but clinical use has been hampered by lack of the randomized trial needed for incorporation into societal guidelines. In patients with ischemic heart disease, cardiac 123I-mIBG imaging aids in assessing the extent of damage and in identifying arrhythmogenic regions. There have also been studies using cardiac 123I-mIBG for other conditions, including patients following heart transplantation, diabetic related cardiac abnormalities and chemotherapy induced cardiotoxicity. Positron emission tomographic adrenergic radiotracers, that improve image quality, have been investigated, especially 11C-meta-hydroxyephedrine, and most recently 18F-fluorbenguan. Cadmium-zinc-telluride cameras also improve image quality. With better spatial resolution and quantification, PET tracers and advanced camera technologies promise to expand the clinical utility of cardiac sympathetic imaging.
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Affiliation(s)
- Ningxin Wan
- Division of Nuclear Medicine, Department of Radiology, and Division of Cardiology, Department of Medicine, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
| | - Mark I Travin
- Division of Nuclear Medicine, Department of Radiology, and Division of Cardiology, Department of Medicine, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY.
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Mastrocola LE, Amorim BJ, Vitola JV, Brandão SCS, Grossman GB, Lima RDSL, Lopes RW, Chalela WA, Carreira LCTF, Araújo JRND, Mesquita CT, Meneghetti JC. Update of the Brazilian Guideline on Nuclear Cardiology - 2020. Arq Bras Cardiol 2020; 114:325-429. [PMID: 32215507 PMCID: PMC7077582 DOI: 10.36660/abc.20200087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Barbara Juarez Amorim
- Universidade Estadual de Campinas (Unicamp), Campinas, SP - Brazil
- Sociedade Brasileira de Medicina Nuclear (SBMN), São Paulo, SP - Brazil
| | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brazil
- Clínica Cardionuclear, Porto Alegre, RS - Brazil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Fonte Imagem Medicina Diagnóstica, Rio de Janeiro, RJ - Brazil
- Clínica de Diagnóstico por Imagem (CDPI), Grupo DASA, Rio de Janeiro, RJ - Brazil
| | | | - William Azem Chalela
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | | | | | - José Claudio Meneghetti
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
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Teresińska A. Iodine-123-metaiodobenzylguanidine cardiac SPECT imaging in the qualification of heart failure patients for ICD implantation. J Nucl Cardiol 2019; 26:1182-1187. [PMID: 29696486 PMCID: PMC6660574 DOI: 10.1007/s12350-018-1288-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Anna Teresińska
- The Cardinal Stefan Wyszyński Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
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Travin MI, Matsunari I, Thomas GS, Nakajima K, Yoshinaga K. How do we establish cardiac sympathetic nervous system imaging with 123I-mIBG in clinical practice? Perspectives and lessons from Japan and the US. J Nucl Cardiol 2019; 26:1434-1451. [PMID: 30178272 DOI: 10.1007/s12350-018-1394-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/27/2018] [Indexed: 02/07/2023]
Abstract
Cardiac denervation is associated with progressive left ventricular (LV) dysfunction, ventricular arrhythmias, and sudden cardiac death (SCD) in heart failure (HF). In this regard, it is important to evaluate cardiac-specific sympathetic nervous system (SNS) function. The radiotracer Iodine-123 meta-iodobenzylguanidine (123I-mIBG) can noninvasively evaluate pre-synaptic SNS function. Recent multicenter trials have shown 123I-mIBG to have strong predictive value for fatal arrhythmias and cardiac death in HF. 123I-mIBG was initially developed in the USA in the 1970s. In 1992, the Japanese Ministry of Health and Labour approved 123I-mIBG for the assessment of cardiac function. Following approval, the Japanese nuclear cardiology community developed 123I-mIBG imaging services in various medical centers. Japanese groups have been trying to establish the clinical utility of 123I-mIBG and standardize parameters for data acquisition and image analysis. The US Food and Drug Administration (FDA) has approved clinical use of 123I-mIBG for cardiac and non-cardiac imaging. However, clinical use of 123I-mIBG in the US has been very limited. The number of 123I-mIBG studies in Japan has also been limited. There are similarities and differences between the two countries. To establish the clinical utility of 123I-mIBG in both countries, it is important to characterize the situations of 123I-mIBG in each.
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Affiliation(s)
- Mark I Travin
- Department of Radiology/Division of Nuclear Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ichiro Matsunari
- Division of Nuclear Medicine, Department of Radiology, Saitama Medical University, Moroyama, Japan
| | - Gregory S Thomas
- Memorial Care Heart, & Vascular Institute, Long Beach Medical Center, Long Beach, CA, USA
- Division of Cardiology, University of California, Irvine, Orange, CA, USA
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Keiichiro Yoshinaga
- Diagnostic and Therapeutic Nuclear Medicine, National Institutes for Quantum and Radiological Science and Technology, National Institute of Radiological Sciences, Chiba, Japan.
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Nakajima K, Nakata T, Doi T, Kadokami T, Matsuo S, Konno T, Yamada T, Jacobson AF. Validation of 2-year 123I-meta-iodobenzylguanidine-based cardiac mortality risk model in chronic heart failure. Eur Heart J Cardiovasc Imaging 2019; 19:749-756. [PMID: 29415138 PMCID: PMC6012774 DOI: 10.1093/ehjci/jey016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/16/2018] [Indexed: 01/04/2023] Open
Abstract
Aims The aim of this study was to validate a four-parameter risk model including 123I-meta-iodobenzylguanidine (MIBG) imaging, which was previously developed for predicting cardiac mortality, in a new cohort of patients with chronic heart failure (CHF). Methods and results Clinical and outcome data were retrospectively obtained from 546 patients (age 66 ± 14 years) who had undergone 123I-MIBG imaging with a heart-to-mediastinum ratio (HMR). The mean follow-up time was 30 ± 20 months, and the endpoint was cardiac death. The mortality outcome predicted by the model was compared with actual 2-year event rates in pre-specified risk categories of three or four risk groups using Kaplan–Meier survival analysis for cardiac death and receiver-operating characteristic (ROC) analysis. Cardiac death occurred in 137 patients, including 105 (68%) patients due to heart-failure death. With a 2-year mortality risk from the model divided into three categories of low- (<4%), intermediate- (4–12%), and high-risk (>12%), 2-year cardiac mortality was 1.1%, 7.9%, and 54.7%, respectively in the validation population (P < 0.0001). In a quartile analysis, although the predicted numbers of cardiac death was comparable with actual number of cardiac death for low- to intermediate-risk groups with a mortality risk <13.8%, it was underestimated in the high-risk group with a mortality risk ≥13.8%. The ROC analysis showed that the 2-year risk model had better (P < 0.0001) diagnostic ability for predicting heart failure death than left ventricular ejection fraction, natriuretic peptides or HMR alone. Conclusion The 2-year risk model was successfully validated particularly in CHF patients at a low to intermediate cardiac mortality risk.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Tomoaki Nakata
- Department of Cardiology, Hakodate-Goryoukaku Hospital, Hakodate, Japan
| | - Takahiro Doi
- Department of Cardiology, Obihiro-Kosei Hospital, Obihiro, Japan
| | - Toshiaki Kadokami
- Department of Cardiology, Saiseikai-Futsukaichi Hospital, Tsukushino, Japan
| | - Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Tetsuo Konno
- Department of Cardiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Takahisa Yamada
- Department of Cardiology, Osaka Prefectural General Medical Center, Osaka, Japan
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Onitsuka H, Koyama S, Ideguchi T, Ishikawa T, Kitamura K, Nagamachi S. Impact of short-acting loop diuretic doses and cardiac sympathetic nerve abnormalities on outcomes of patients with reduced left ventricular function. Medicine (Baltimore) 2019; 98:e14657. [PMID: 30813209 PMCID: PMC6407956 DOI: 10.1097/md.0000000000014657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Recent studies reported that high doses of short-acting loop diuretics are associated with poor outcomes in patients with heart failure (HF). Short-acting loop diuretics have been shown to activate the renin-angiotensin system (RAS) and have no favorable effects on cardiac sympathetic nervous system (SNS) activity. The goal of this study is to investigate the relationship between daily doses of furosemide and the outcomes of patients with left ventricular dysfunction (LVD) from the viewpoint of cardiac SNS abnormalities using iodine-123-labeled metaiodobenzylguanidine (l-MIBG) myocardial scintigraphy.We enrolled 137 hospitalized patients (62.5 ± 14.2 years old, 103 men) with LVEF < 45% who underwent l-MIBG myocardial scintigraphy. A delayed heart-to-mediastinum ratio (delayed HMR) was assessed using l-MIBG scintigraphy. Cardiac events were defined as cardiac death or re-hospitalization due to the deterioration of HF. Cox proportional hazard analysis was used to identify predictors of cardiac events.Cardiac events occurred in 57 patients in a follow-up period of 33.1 ± 30 months. In a multivariate Cox proportional hazard analysis, delayed HMR and furosemide doses were identified as independent predictors of cardiac events (P = .0042, P = .033, respectively). Inverse probability of treatment weighting Cox modeling showed that the use of furosemide (≥40 mg /day) was associated with cardiac events with a hazard ratio of 1.96 (P = .003). In the Kaplan-Mayer analysis, the cardiac event-free survival rate was significantly lower in patients treated with high doses of furosemide (≥60 mg/day vs 40-60 mg/day vs <40 mg/day, the Log-rank test P < .0001). In a receiver-operating characteristic (ROC) analysis, the cut-off value for cardiac events was 40 mg/day of furosemide. The cardiac event-free rate was significantly lower in patients with delayed HMR <1.8 (median value) and receiving furosemide ≥40 mg/day than in other patients (the Log-rank test P < .0001). Significant differences in cardiac event rates according to furosemide doses among patients with delayed HMR <1.8 were observed among patients without β-blocker therapy (P = .001), but not among those with β-blocker therapy (P = .127).The present results indicate that a relationship exists between higher doses of furosemide and poor outcomes. The prognosis of HF patients with severe cardiac SNS abnormalities receiving high-dose short-acting loop diuretics is poor.
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Age- and sex-dependent changes in sympathetic activity of the left ventricular apex assessed by 18F-DOPA PET imaging. PLoS One 2018; 13:e0202302. [PMID: 30106984 PMCID: PMC6091960 DOI: 10.1371/journal.pone.0202302] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 07/31/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sexual dimorphism in cardiac sympathetic outflow has recently gained attention in the context of Takotsubo cardiomyopathy. Previous studies suggest that there are sex- and age-dependent differences in peripheral autonomic control, however, data on cardiac-specific sympathetic activation in aged women and men are lacking. METHODS AND RESULTS Regional quantitative analysis of cardiac fluorine-18 (18F)- Dihydroxyphenylalanine (DOPA) uptake was retrospectively performed in 133 patients (69 females, mean age 52.4±17.7 years) referred for assessment of neuroendocrine tumours (NET) by Positron-Emission-Tomography. Cardiac 18F-DOPA uptake was significantly higher in women as compared to men (1.33±0.21 vs. 1.18±0.24, p<0.001). This sex-difference was most pronounced in the apical region of the left ventricle (LV, 1.30±0.24 in women vs. 1.13±0.25 in men, p<0.001) and in individuals >55 years of age (1.39±0.25 in women vs. 1.09±0.24 in men, p<0.001). Women showed a prominent increase in myocardial 18F-DOPA uptake with age with the strongest increase seen in the LV apical region (r = 0.34, p = 0.004). Accordingly, sex and age were selected as significant predictors of LV apical 18F-DOPA uptake in a stepwise linear regression model. No age-dependent changes of cardiac 18F-DOPA uptake were observed in men or in the right ventricular region. CONCLUSION Our study suggests that aging is related to sex-specific changes in regional cardiac sympathetic activity. Future studies will have to assess whether the increase in LV apical 18F-DOPA uptake with age in women is of pathogenic relevance for the higher susceptibility of postmenopausal women to conditions associated with increased sympathetic activity.
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Iqbal B, Currie G, Kiat H. Regional Cardiac Sympathetic Nervous System Evaluation Using 123I-mIBG SPECT in Patients with Heart Failure. J Med Imaging Radiat Sci 2018; 49:397-405. [PMID: 30514557 DOI: 10.1016/j.jmir.2018.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 11/18/2022]
Abstract
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 metaiodobenzylguanidine (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.
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Affiliation(s)
- Basit Iqbal
- Pakistan Institute of Engineering & Applied Sciences, Islamabad, Pakistan; School of Dentistry & Health Sciences, Charles Sturt University, Wagga Wagga, Australia
| | - Geoff Currie
- School of Dentistry & Health Sciences, Charles Sturt University, Wagga Wagga, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
| | - Hosen Kiat
- School of Dentistry & Health Sciences, Charles Sturt University, Wagga Wagga, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Cardiac Health Institute, Sydney, Australia
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Woo SK, Moon BS, Kim BS, Kim MH, Lee YJ, Jung JH, Lee KC, Seo Y, Kim W, Lim SM, Lee BC, Kim SE. Feasibility of myocardial PET imaging using a benzylguanidine analog: meta-(3-[ 18F]fluoropropyl)benzylguanidine ([ 18F]mFPBG). Nucl Med Biol 2018; 61:63-70. [PMID: 29783202 DOI: 10.1016/j.nucmedbio.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/04/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Global and regional sympathetic activity in the heart can be evaluated using [123I]meta-iodobenzylguanidine ([123I]mIBG) imaging. However, [123I]mIBG is associated with low image spatial resolution and sensitivity in cardiac imaging. We investigated the capability of an F-18-labeled mIBG derivative, meta-(3-[18F]fluoropropyl)benzylguanidine ([18F]mFPBG), for identifying ischemic and viable myocardium in a rat model of myocardial infarction. MATERIALS AND METHODS The ex vivo biodistribution and in vivo metabolic stability of [18F]mFPBG were investigated in Sprague-Dawley rats. Selective cardiac adrenergic activation was confirmed via a blocking experiment involving pretreatment with desipramine (2 mg kg-1), followed by the administration of [18F]mFPBG. Imaging properties of [18F]mFPBG were compared with those of traditional cardiac imaging radiotracers ([123I]mIBG and [99mTc]MIBI) in a rat model of myocardial infarction. Non-invasive image-based measurements of infarct sizes were then compared with histological findings by using Bland-Altman analysis. RESULTS The differences in infarct sizes determined using histological analysis and [18F]mFPBG PET were -2.55 ± 4.99% (range: -12.33 to 7.22), -2.35 ± 3.32% (range: -8.87 to 4.16), and -3.15 ± 6.16% (range: -15.24 to 8.93) at 5, 20, and 40 min, respectively. Furthermore, [18F]mFPBG PET was superior to traditional imaging methods in assessing the degree of ischemia in areas of myocardial infarction, as well as the actual infarct size. CONCLUSION Compared to [123I]mIBG, [18F]mFPBG showed improved spatial resolution and sensitivity in a rat model of myocardial infarction. This result suggested that [18F]mFPBG is a promising cardiac PET imaging agent for potential diagnostic application in PET cardiology.
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Affiliation(s)
- Sang-Keun Woo
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Byung Seok Moon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Bom Sahn Kim
- Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul 07985, Republic of Korea
| | - Min Hwan Kim
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Yong Jin Lee
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Jae Ho Jung
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Kyo Chul Lee
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Youngho Seo
- Department of Radiology, University of California San Francisco School of Medicine, San Francisco, CA 94143, USA
| | - Wook Kim
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Sang Moo Lim
- Division of RI-Convergence Research, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Byung Chul Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; Center for Nanomolecular Imaging and Innovative Drug Development, Advanced Institutes of Convergence Technology, Suwon 16229, Republic of Korea.
| | - Sang Eun Kim
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; Center for Nanomolecular Imaging and Innovative Drug Development, Advanced Institutes of Convergence Technology, Suwon 16229, Republic of Korea; Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 08826, Republic of Korea
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Nakajima K, Okuda K, Matsuo S, Wakabayashi H, Kinuya S. Is 123I-metaiodobenzylguanidine heart-to-mediastinum ratio dependent on age? From Japanese Society of Nuclear Medicine normal database. Ann Nucl Med 2018; 32:175-181. [PMID: 29333564 PMCID: PMC5852176 DOI: 10.1007/s12149-018-1231-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/09/2018] [Indexed: 10/26/2022]
Abstract
BACKGROUND Heart-to-mediastinum ratios (HMRs) of 123I-metaiodobenzylguanidine (MIBG) have usually been applied to prognostic evaluations of heart failure and Lewy body disease. However, whether these ratios depend on patient age has not yet been clarified using normal databases. METHODS We analyzed 62 patients (average age 57 ± 19 years, male 45%) derived from a normal database of the Japanese Society of Nuclear Medicine working group. The HMR was calculated from early (15 min) and delayed (3-4 h) anterior planar 123I-MIBG images. All HMRs were standardized to medium-energy general purpose (MEGP) collimator equivalent conditions using conversion coefficients for the collimator types. Washout rates (WR) were also calculated, and we analyzed whether early and late HMR, and WR are associated with age. RESULTS Before standardization of HMR to MEGP collimator conditions, HMR and age did not significantly correlate. However, late HMR significantly correlated with age after standardization: late HMR = - 0.0071 × age + 3.69 (r2 = 0.078, p = 0.028), indicating that a 14-year increase in age corresponded to a decrease in HMR of 0.1. Whereas the lower limit (2.5% quantile) of late HMR was 2.3 for all patients, it was 2.5 and 2.0 for those aged ≤ 63 and > 63 years, respectively. Early HMR tended to be lower in subjects with the higher age (p = 0.076), whereas WR was not affected by age. CONCLUSION While late HMR was slightly decreased in elderly patients, the lower limit of 2.2-2.3 can still be used to determine both early and late HMR.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Uchinada, Kahoku, Japan
| | - Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroshi Wakabayashi
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Klene C, Jungen C, Okuda K, Kobayashi Y, Helberg A, Mester J, Meyer C, Nakajima K. Influence of ROI definition on the heart-to-mediastinum ratio in planar 123I-MIBG imaging. J Nucl Cardiol 2018; 25:208-216. [PMID: 27804071 DOI: 10.1007/s12350-016-0708-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Iodine-123-metaiodobenzylguanidine (123I-MIBG) imaging with estimation of the heart-to-mediastinum ratio (HMR) has been established for risk assessment in patients with chronic heart failure. Our aim was to evaluate the effect of different methods of ROI definition on the renderability of HMR to normal or decreased sympathetic innervation. METHODS AND RESULTS The results of three different methods of ROI definition (clinical routine (CLI), simple standardization (STA), and semi-automated (AUT) were compared. Ranges of 95% limits of agreement (LoA) of inter-observer variabilities were 0.28 and 0.13 for STA and AUT, respectively. Considering a HMR of 1.60 as the lower limit of normal, 13 of 32 (41%) for method STA and 5 of 32 (16%) for method AUT of all HMR measurements could not be classified to normal or pathologic. Ranges of 95% LoA of inter-method variabilities were 0.72 for CLI vs AUT, 0.65 for CLI vs STA, and 0.31 for STA vs AUT. CONCLUSION Different methods of ROI definition result in different ranges of the LoA of the measured HMR with relevance for rendering the results to normal or pathological innervation. We could demonstrate that standardized protocols can help keep methodological variabilities limited, narrowing the gray zone of renderability.
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Affiliation(s)
- Christiane Klene
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Christiane Jungen
- Department of Cardiology - Electrophysiology, University Heart Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Germany), Berlin, Germany
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Uchinada, Kahoku, Japan
| | - Yuske Kobayashi
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Annabelle Helberg
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Janos Mester
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology - Electrophysiology, University Heart Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Germany), Berlin, Germany
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
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Lairez O, Legallois D, Agostini D. Sympathetic nervous system, systolic heart failure, and central sleep apnea: Are we about to find the missing link? J Nucl Cardiol 2017; 24:1938-1940. [PMID: 27457530 DOI: 10.1007/s12350-016-0584-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Olivier Lairez
- Département de Médecine Nucléaire, CHU Rangueil, Toulouse, France
| | - Damien Legallois
- Service de Cardiologie, CHU Côte de Nacre, Caen, France
- Service de Médecine Nucléaire, CHU Côte de Nacre, Caen, France
| | - Denis Agostini
- Service de Médecine Nucléaire, CHU Côte de Nacre, Caen, France.
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Owenius R, Zanette M, Cella P. Variability in Heart-to-Mediastinum Ratio from Planar 123I-MIBG Images of a Thorax Phantom for 6 Common γ-Camera Models. J Nucl Med Technol 2017; 45:297-303. [PMID: 29042467 DOI: 10.2967/jnmt.117.196055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/05/2017] [Indexed: 01/08/2023] Open
Abstract
A heart-to-mediastinum (H/M) ratio of 1.6 or greater on planar 123I-iobenguane (123I-MIBG) images identifies heart failure patients at low risk of experiencing an adverse cardiac event. This phase-4 study used standardized phantoms to assess the intercamera, intracamera, and interhead variability in H/M ratio determinations from planar cardiac 123I-MIBG imaging using commercially available, dual-head γ-cameras. Methods: A fillable thorax phantom was developed to simulate the typical uptake of 123I-MIBG. The phantom had a nominal H/M ratio of 1.6 on the reference camera. Commercial cameras used in the study were dual-head and capable of 90° configuration for cardiac imaging. The target sample size was 8 units (examples) per camera model. Two imaging technologists independently analyzed planar images of simulated 123I-MIBG uptake from the thorax phantom. H/M was the ratio of the average counts per pixel of the heart and mediastinum regions of interest. The primary endpoint, intercamera variability in H/M ratio from head 1, was determined for each camera model via comparison with the H/M ratio on the reference camera. Only cameras with at least 8 units tested (n ≥ 8) were included in the primary analysis. Intracamera and interhead variability in the H/M ratio were also evaluated. Results: Nine camera models were studied. The mean H/M ratio ranged from 1.342 to 1.677. The primary analysis (6 camera models) using a mixed-model, repeated-measures analysis showed no significant difference in H/M ratio between any camera model and the reference camera. Intracamera variability (head 1) in the H/M ratio among camera models with 8 units or more was high, with SDs ranging from 0.0455 to 0.1193. Interhead variability was low (SDs of the interhead difference, 0.017-0.074). Conclusion: Commonly used γ-cameras produced H/M ratios from simulated 123I-MIBG phantom images that were not significantly different from those on the reference camera. This finding indicates that the results of previous clinical trials of 123I-MIBG, involving many different clinical sites and camera models, are valid. The assessment of the performance of a given camera unit using an 123I planar phantom before H/M results from 123I-MIBG imaging are used for classifying risk in heart failure patients is encouraged.
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Affiliation(s)
- Rikard Owenius
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden; and
| | - Michelle Zanette
- GE Healthcare, Life Sciences, Imaging R&D, Marlborough, Massachusetts
| | - Patrick Cella
- GE Healthcare, Life Sciences, Imaging R&D, Marlborough, Massachusetts
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Bax JJ. Clinical utility of cardiac innervation imaging in patients with heart failure. J Nucl Cardiol 2017; 24:1594-1597. [PMID: 28699069 DOI: 10.1007/s12350-017-0988-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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Nakajima K, Okuda K, Yokoyama K, Yoneyama T, Tsuji S, Oda H, Yoshita M, Kubota K. Cross calibration of 123I-meta-iodobenzylguanidine heart-to-mediastinum ratio with D-SPECT planogram and Anger camera. Ann Nucl Med 2017; 31:605-615. [PMID: 28689357 PMCID: PMC5622915 DOI: 10.1007/s12149-017-1191-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/01/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cardiac 123I-meta-iodobenzylguanidine (MIBG) uptake is quantified using the heart-to-mediastinum ratio (HMR) with an Anger camera. The relationship between HMR determined using D-SPECT with a cadmium-zinc-telluride detector and an Anger camera is not fully understood. Therefore, the present study aimed to define this relationship using images derived from a phantom and from patients. METHODS Cross-calibration phantom studies using an Anger camera with a low-energy high-resolution (LEHR) collimator and D-SPECT, and clinical 123I-MIBG studies proceeded in 40 consecutive patients (80 studies). In the phantom study, a conversion coefficient (CC) was defined based on phantom experiments and applied to the Anger camera and the D-SPECT detector. The HMR was calculated using anterior images with the Anger camera and anterior planograms with D-SPECT. First, the HMR from D-SPECT was cross-calibrated to the Anger camera, and then, the HMR from both cameras were converted to the medium-energy general-purpose collimator condition (CC 0.88; ME88 condition). The relationship between HMR and corrected and uncorrected methods was examined. A 123I-MIBG washout rate was calculated using both methods with and without background subtraction. RESULTS Based on the phantom experiments, the CC of the Anger camera with an LEHR collimator and of D-SPECT using an anterior planogram was 0.55 and 0.63, respectively. The original HMR from the Anger camera and D-SPECT was 1.76 ± 0.42 and 1.86 ± 0.55, respectively (p < 0.0001). After D-SPECT HMR was converted to the Anger camera condition, the corrected D-SPECT HMR became comparable to the values under the Anger camera condition (1.75 ± 0.48, p = n. s.). When the HMR measured using the two cameras were converted under the ME88 condition, the average standardized HMR from the Anger camera and D-SPECT became comparable (2.21 ± 0.65 vs. 2.20 ± 0.75, p = n. s.). After standardization to the ME88 condition, a systematic difference in the linear regression lines disappeared, and the HMR from both the Anger (StdHMRAnger) and D-SPECT (StdHMRDSPECT) became comparable. Additional correction using a regression line further improved the relationship between both HMR [StdHMRDSPECT = 0.09 + 0.98 × StdHMRAnger (R 2 = 0.91)]. The washout rate closely correlated with and without background correction between both methods (R 2 = 0.83 and 0.65, respectively). CONCLUSION The phantom-based conversion method is applicable to D-SPECT and enables the common application of HMR irrespective of D-SPECT and the Anger camera.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
- PET Imaging Center, Public Central Hospital of Matto Ishikawa, Hakusan, Japan.
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Uchinada, Kahoku, Japan
| | - Kunihiko Yokoyama
- PET Imaging Center, Public Central Hospital of Matto Ishikawa, Hakusan, Japan
| | - Tatsuya Yoneyama
- PET Imaging Center, Public Central Hospital of Matto Ishikawa, Hakusan, Japan
| | - Shiro Tsuji
- PET Imaging Center, Public Central Hospital of Matto Ishikawa, Hakusan, Japan
| | - Hiroyuki Oda
- Department of Cardiology, Public Central Hospital of Matto Ishikawa, Hakusan, Japan
| | | | - Koji Kubota
- Department of Cardiology, Public Central Hospital of Matto Ishikawa, Hakusan, Japan
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Alvi R, Miller EJ, Zonouz TH, Sandoval V, Tariq N, Lampert R, Sinusas AJ, Liu YH. Quantification and Determination of Normal 123I-Meta Iodobenzylguanidine Heart-to-Mediastinum Ratio (HMR) from Cardiac SPECT/CT and Correlation with Planar HMR. J Nucl Med 2017; 59:652-658. [DOI: 10.2967/jnumed.117.197152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/30/2017] [Indexed: 01/08/2023] Open
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Verschure DO, de Groot JR, Mirzaei S, Gheysens O, Nakajima K, van Eck-Smit BLF, Aernout Somsen G, Verberne HJ. Cardiac 123I-mIBG scintigraphy is associated with freedom of appropriate ICD therapy in stable chronic heart failure patients. Int J Cardiol 2017; 248:403-408. [PMID: 28847545 DOI: 10.1016/j.ijcard.2017.08.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/10/2017] [Accepted: 08/03/2017] [Indexed: 11/24/2022]
Abstract
AIM Chronic heart failure (CHF) is a life-threatening clinical syndrome, partly due to sudden cardiac death (SCD). Implantable cardioverter defibrillators (ICD) for primary prevention of SCD have improved overall survival of CHF patients. However, a high percentage of patients never receives appropriate ICD therapy. This prospective multicentre study evaluated whether cardiac sympathetic activity assessed by 123I-mIBG scintigraphy could be helpful in selecting patients for ICD implantation. MATERIALS AND METHODS 135 stable CHF subjects (age 64.5±9.3years, 79% male, LVEF 25±6%) referred for prophylactic ICD implantation were enrolled in 13 institutions. All subjects underwent planar and SPECT 123I-mIBG scintigraphy. Early and late heart-to-mediastinum (H/M) ratio, 123I-mIBG washout (WO) and late summed scores were calculated. The primary endpoint was appropriate ICD therapy. The secondary endpoint was defined as the combined endpoint of all first cardiac events: appropriate ICD therapy, progression of heart failure (HF) and cardiac death. RESULTS During a median follow-up of 30months (6-68months), 24 subjects (17.8%) experienced a first cardiac event (appropriate ICD therapy [12], HF progression [6], cardiac death [6]). Late H/M ratio and defect size of 123I-mIBG SPECT were not associated with appropriate ICD therapy. However, late H/M ratio was independently associated with the combined endpoint (HR 0.135 [0.035-0.517], p=0.001). Post-hoc analysis showed that the combination of late H/M ratio (HR 0.461 [0.281-0.757]) and LVEF (HR 1.052 [1.021-1.084]) was significantly associated with freedom of appropriate ICD therapy (p<0.001). CONCLUSION 123I-mIBG scintigraphy seems to be helpful in selecting CHF subjects who might not benefit from ICD implantation.
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Affiliation(s)
- Derk O Verschure
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Zaans Medical Center, Zaandam, The Netherlands.
| | - Joris R de Groot
- Heart Center, Department of Cardiology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Siroos Mirzaei
- Department of Nuclear Medicine, Wilhelminenspital, Vienna, Austria
| | - Olivier Gheysens
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Berthe L F van Eck-Smit
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G Aernout Somsen
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Hein J Verberne
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Nakajima K, Scholte AJHA, Nakata T, Dimitriu-Leen AC, Chikamori T, Vitola JV, Yoshinaga K. Cardiac sympathetic nervous system imaging with 123I-meta-iodobenzylguanidine: Perspectives from Japan and Europe. J Nucl Cardiol 2017; 24:952-960. [PMID: 28290098 DOI: 10.1007/s12350-017-0818-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
Cardiac sympathetic nervous system dysfunction is closely associated with risk of serious cardiac events in patients with heart failure (HF), including HF progression, pump-failure death, and sudden cardiac death by lethal ventricular arrhythmia. For cardiac sympathetic nervous system imaging, 123I-meta-iodobenzylguanidine (123I-MIBG) was approved by the Japanese Ministry of Health, Labour and Welfare in 1992 and has therefore been widely used since in clinical settings. 123I-MIBG was also later approved by the Food and Drug Administration (FDA) in the United States of America (USA) and it was expected to achieve broad acceptance. In Europe, 123I-MIBG is currently used only for clinical research. This review article is based on a joint symposium of the Japanese Society of Nuclear Cardiology (JSNC) and the American Society of Nuclear Cardiology (ASNC), which was held in the annual meeting of JSNC in July 2016. JSNC members and a member of ASNC discussed the standardization of 123I-MIBG parameters, and clinical aspects of 123I-MIBG with a view to further promoting 123I-MIBG imaging in Asia, the USA, Europe, and the rest of the world.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tomoaki Nakata
- Department of Cardiology, Hakodate Goryokaku Hospital, Hakodate, Japan
| | | | | | | | - Keiichiro Yoshinaga
- Diagnostic and Therapeutic Nuclear Medicine, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-Ku, Chiba, 263-8555, Japan.
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42
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Nakajima K, Verschure DO, Okuda K, Verberne HJ. Standardization of 123I- meta-iodobenzylguanidine myocardial sympathetic activity imaging: phantom calibration and clinical applications. Clin Transl Imaging 2017; 5:255-263. [PMID: 28596948 PMCID: PMC5437131 DOI: 10.1007/s40336-017-0230-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/19/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE Myocardial sympathetic imaging with 123I-meta-iodobenzylguanidine (123I-mIBG) has gained clinical momentum. Although the need for standardization of 123I-mIBG myocardial uptake has been recognized, the availability of practical clinical standardization approaches is limited. The need for standardization includes the heart-to-mediastinum ratio (HMR) and washout rate with planar imaging, and myocardial defect scoring with single-photon emission computed tomography (SPECT). METHODS The planar HMR shows considerable variation due to differences in collimator design. These camera-collimator differences can be overcome by cross-calibration phantom experiments. The principles of these cross-calibration phantom experiments are summarized in this article. 123I-mIBG SPECT databases were compiled by Japanese Society of Nuclear Medicine working group. Literature was searched based on the words "123I-mIBG quantification method", "standardization", "heart-to-mediastinum ratio", and its application to "risk model". RESULTS Calibration phantom experiments have been successfully performed in Japan and Europe. The benefit of these cross-calibration phantom experiments is that variation in the HMR between institutions is minimized including low-energy, low-medium-energy and medium-energy collimators. The use of myocardial 123I-mIBG SPECT can be standardized using 123I-mIBG normal databases as a basis for quantitative evaluation. This standardization method can be applied in cardiac event prediction models. CONCLUSION Standardization of myocardial 123I-mIBG outcome parameters may facilitate a universal implementation of myocardial 123I-mIBG scintigraphy.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Derk O. Verschure
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Cardiology, Zaans Medical Center, Zaandam, The Netherlands
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Uchinada, Kahoku, Japan
| | - Hein J. Verberne
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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43
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Travin MI, Henzlova MJ, van Eck-Smit BLF, Jain D, Carrió I, Folks RD, Garcia EV, Jacobson AF, Verberne HJ. 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. J Nucl Cardiol 2017; 24:377-391. [PMID: 26791866 DOI: 10.1007/s12350-015-0336-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/28/2015] [Indexed: 01/08/2023]
Abstract
RATIONALE 123I-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 123I-mIBG and 99mTc-tetrofosmin SPECT are predictive of arrhythmic events (ArEs). METHODS 123I-mIBG SPECT images from 622 patients with ischemic HF were presented in standard displays alongside 99mTc-tetrofosmin images. Consensus interpretations using a 17-segment model produced summed scores. Cox proportional hazards analyses related findings to adjudicated ArEs over 2 years. RESULTS 471 patients had images adequate for total 17-segment scoring. There were 48 ArEs (10.2%). Neither 123I-mIBG nor 99mTc-tetrofosmin SPECT summed scores were univariate predictors. On multivariate proportional hazards analysis, the 123I-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. CONCLUSIONS The presumption of a monotonic increase in ArE risk with increasing summed 123I-mIBG SPECT score may not be correct as ischemic HF patients with abnormalities of intermediate extent appear at highest risk.
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Affiliation(s)
- Mark I Travin
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East-210th Street, Bronx, NY, 10467-2490, USA.
| | | | - Berthe L F van Eck-Smit
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Diwakar Jain
- Division of Cardiology, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Ignasi Carrió
- Department of Nuclear Medicine, Hospital Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Russell D Folks
- Department of Radiology, Emory University Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Ernest V Garcia
- Department of Radiology, Emory University Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Arnold F Jacobson
- Diagram Consulting, Kihei, HI, USA
- Formerly Employed by GE Healthcare, Kihei, HI, USA
| | - Hein J Verberne
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Laursen AH, Thune JJ, Hutchings M, Hasbak P, Kjaer A, Elming MB, Ripa RS. 123
I-MIBG imaging for detection of anthracycline-induced cardiomyopathy. Clin Physiol Funct Imaging 2017; 38:176-185. [DOI: 10.1111/cpf.12419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/19/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Adam H. Laursen
- Department of Haematology; Rigshospitalet; Copenhagen Denmark
| | | | | | - Philip Hasbak
- Department of Clinical Physiology; Nuclear Medicine & PET and Cluster for Molecular Imaging; Rigshospitalet and University of Copenhagen; Copenhagen Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology; Nuclear Medicine & PET and Cluster for Molecular Imaging; Rigshospitalet and University of Copenhagen; Copenhagen Denmark
| | - Marie B. Elming
- Department of Cardiology; Rigshospitalet; Copenhagen Denmark
| | - Rasmus S. Ripa
- Department of Clinical Physiology; Nuclear Medicine & PET and Cluster for Molecular Imaging; Rigshospitalet and University of Copenhagen; Copenhagen Denmark
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Angelidis G, Giamouzis G, Karagiannis G, Butler J, Tsougos I, Valotassiou V, Giannakoulas G, Dimakopoulos N, Xanthopoulos A, Skoularigis J, Triposkiadis F, Georgoulias P. SPECT and PET in ischemic heart failure. Heart Fail Rev 2017; 22:243-261. [DOI: 10.1007/s10741-017-9594-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Verschure DO, van Eck-Smit BLF, Somsen GA, Knol RJJ, Verberne HJ. Cardiac sympathetic activity in chronic heart failure: cardiac 123I-mIBG scintigraphy to improve patient selection for ICD implantation. Neth Heart J 2016; 24:701-708. [PMID: 27677744 PMCID: PMC5120011 DOI: 10.1007/s12471-016-0902-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Heart failure is a life-threatening disease with a growing incidence in the Netherlands. This growing incidence is related to increased life expectancy, improvement of survival after myocardial infarction and better treatment options for heart failure. As a consequence, the costs related to heart failure care will increase. Despite huge improvements in treatment, the prognosis remains unfavourable with high one-year mortality rates. The introduction of implantable devices such as implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) has improved the overall survival of patients with chronic heart failure. However, after ICD implantation for primary prevention in heart failure a high percentage of patients never have appropriate ICD discharges. In addition 25–50 % of CRT patients have no therapeutic effect. Moreover, both ICDs and CRTs are associated with malfunction and complications (e. g. inappropriate shocks, infection). Last but not least is the relatively high cost of these devices. Therefore, it is essential, not only from a clinical but also from a socioeconomic point of view, to optimise the current selection criteria for ICD and CRT. This review focusses on the role of cardiac sympathetic hyperactivity in optimising ICD selection criteria. Cardiac sympathetic hyperactivity is related to fatal arrhythmias and can be non-invasively assessed with 123I-meta-iodobenzylguanide (123I-mIBG) scintigraphy. We conclude that cardiac sympathetic activity assessed with 123I-mIBG scintigraphy is a promising tool to better identify patients who will benefit from ICD implantation.
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Affiliation(s)
- D O Verschure
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Cardiology, Zaans Medical Center, Zaandam, The Netherlands.
| | - B L F van Eck-Smit
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G A Somsen
- Cardiology Centres of the Netherlands, Amsterdam, The Netherlands
| | - R J J Knol
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - H J Verberne
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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47
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Nakajima K, Yamada M. (123)I-Meta-iodobenzylguanidine Sympathetic Imaging: Standardization and Application to Neurological Diseases. Chonnam Med J 2016; 52:145-50. [PMID: 27689024 PMCID: PMC5040763 DOI: 10.4068/cmj.2016.52.3.145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 05/17/2016] [Accepted: 06/13/2016] [Indexed: 11/08/2022] Open
Abstract
123I-meta-iodobenzylguanidine (MIBG) has become widely applied in Japan since its introduction to clinical cardiology and neurology practice in the 1990s. Neurological studies found decreased cardiac uptake of 123I-MIBG in Lewy-body diseases including Parkinson's disease and dementia with Lewy bodies. Thus, cardiac MIBG uptake is now considered a biomarker of Lewy body diseases. Although scintigraphic images of 123I-MIBG can be visually interpreted, an average count ratio of heart-to-mediastinum (H/M) has commonly served as a semi-quantitative marker of sympathetic activity. Since H/M ratios significantly vary according to acquisition and processing conditions, quality control should be appropriate, and quantitation should be standardized. The threshold H/M ratio for differentiating Lewy-body disease is 2.0-2.1, and was based on standardized H/M ratios to comparable values of medium-energy collimators. Parkinson's disease can be separated from various types of parkinsonian syndromes using cardiac 123I-MIBG, whereas activity is decreased on images of Lewy-body diseases using both 123I-ioflupane for the striatum and 123I-MIBG. Despite being a simple index, the H/M ratio of 123I-MIBG uptake is reproducible and can serve as an effective tool to support a diagnosis of Lewy-body diseases in neurological practice.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University, Kanazawa, Japan
| | - Masahito Yamada
- Department of Neurology, Kanazawa University, Kanazawa, Japan
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Melero-Ferrer JL, López-Vilella R, Morillas-Climent H, Sanz-Sánchez J, Sánchez-Lázaro IJ, Almenar-Bonet L, Martínez-Dolz L. Novel Imaging Techniques for Heart Failure. Card Fail Rev 2016; 2:27-34. [PMID: 28875038 DOI: 10.15420/cfr.2015:29:2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Imaging techniques play a main role in heart failure (HF) diagnosis, assessment of aetiology and treatment guidance. Echocardiography is the method of choice for its availability, cost and it provides most of the information required for the management and follow up of HF patients. Other non-invasive cardiac imaging modalities, such as cardiovascular magnetic resonance (CMR), nuclear imaging-positron emission tomography (PET) and single-photon emission computed tomography (SPECT) and computed tomography (CT) could provide additional aetiological, prognostic and therapeutic information, especially in selected populations. This article reviews current indications and possible future applications of imaging modalities to improve the management of HF patients.
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Affiliation(s)
- Josep L Melero-Ferrer
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Raquel López-Vilella
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Herminio Morillas-Climent
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Jorge Sanz-Sánchez
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Ignacio J Sánchez-Lázaro
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Luis Almenar-Bonet
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
| | - Luis Martínez-Dolz
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe,Valencia, Spain
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Hachamovitch R, Nutter B, Menon V, Cerqueira MD. Predicting Risk Versus Predicting Potential Survival Benefit Using 123I-mIBG Imaging in Patients With Systolic Dysfunction Eligible for Implantable Cardiac Defibrillator Implantation: Analysis of Data From the Prospective ADMIRE-HF Study. Circ Cardiovasc Imaging 2016; 8:CIRCIMAGING.114.003110. [PMID: 26666380 DOI: 10.1161/circimaging.114.003110] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiac (123)I-metaiodobenzylguanidine ((123)I-mIBG) imaging improves prognostication in patients with left ventricular (LV) dysfunction. Whether (123)I-mIBG can identify optimal candidates for implantable cardiac defibrillator (ICD) placement is unclear. We examined whether (123)I-mIBG enhances risk assessment and identifies patients with enhanced survival with ICD in a patient cohort with reduced LV function who were candidates for ICD implantation. METHODS AND RESULTS We identified 777 patients (66 sites, 12 countries) without ICD at the time of enrollment in Adreview Myocardial Imaging for Risk Evaluation in Heart Failure (ADMIRE-HF) and index (123)I-mIBG study. Patients completed prescribed study protocol and follow-up. Heart-to-mediastinum (H/M) ratio was determined from (123)I-mIBG results. Survival modeling used a Cox proportional hazards mixed-effects model, including a propensity score, to adjust for nonrandomized ICD implantation after (123)I-mIBG. All-cause death occurred in 75 patients (9.6%), and 196 (25%) patients had ICD implantation on follow-up. After adjusting for multiple factors, although the H/M ratio added incremental prognostic value and enhanced reclassification, neither H/M results, BNP levels, nor left ventricular ejection fraction interacted with ICD use in the survival model, indicating that these variables did not identify patients with enhanced survival with ICD implantation. Nonetheless, H/M results did identify the number of lives saved by ICD use per 100 treated. CONCLUSIONS We found that although (123)I-mIBG imaging enhances the risk stratification of patients with left ventricular dysfunction who are ICD candidates, it does not identify which patients may have improved survival with ICD placement. However, (123)I-mIBG identifies the absolute benefit gained with ICD use, thus may play a role in optimizing the cost-effectiveness of this intervention. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00126425 and NCT00126438.
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Affiliation(s)
- Rory Hachamovitch
- From the Cardiovascular Imaging Section, Department of Cardiovascular Medicine Heart and Vascular Institute (R.H., V.M., M.D.C.), Department of Quantitative Health Science (B.N.), and Department of Nuclear Medicine, Imaging Institute (M.D.C.), Cleveland Clinic, OH.
| | - Benjamin Nutter
- From the Cardiovascular Imaging Section, Department of Cardiovascular Medicine Heart and Vascular Institute (R.H., V.M., M.D.C.), Department of Quantitative Health Science (B.N.), and Department of Nuclear Medicine, Imaging Institute (M.D.C.), Cleveland Clinic, OH
| | - Venu Menon
- From the Cardiovascular Imaging Section, Department of Cardiovascular Medicine Heart and Vascular Institute (R.H., V.M., M.D.C.), Department of Quantitative Health Science (B.N.), and Department of Nuclear Medicine, Imaging Institute (M.D.C.), Cleveland Clinic, OH
| | - Manuel D Cerqueira
- From the Cardiovascular Imaging Section, Department of Cardiovascular Medicine Heart and Vascular Institute (R.H., V.M., M.D.C.), Department of Quantitative Health Science (B.N.), and Department of Nuclear Medicine, Imaging Institute (M.D.C.), Cleveland Clinic, OH
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50
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García-González P, Fabregat-Andrés Ó, Cozar-Santiago P, Sánchez-Jurado R, Estornell-Erill J, Valle-Muñoz A, Quesada-Dorador A, Payá-Serrano R, Ferrer-Rebolleda J, Ridocci-Soriano F. Cardiac sympathetic innervation assessed with 123 I-MIBG retains prognostic utility in diabetic patients with severe left ventricular dysfunction evaluated for primary prevention implantable cardioverter-defibrillator. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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