Prognostic Significance of Cardiac 123I-MIBG SPECT Imaging in Heart Failure Patients With Preserved Ejection Fraction.

Abstract

OBJECTIVES:

The authors sought to elucidate the prognostic value of cardiac sympathetic nerve dysfunction as evaluated using iodine-123-labeled metaiodobenzylguanidine (123I-MIBG) single-photon emission computed tomography (SPECT) imaging in patients with heart failure (HF) with preserved left ventricular ejection fraction (HFpEF).

BACKGROUND:

Cardiac sympathetic nerve dysfunction assessed by 123I-MIBG imaging is associated with poor outcomes in chronic HF patients with reduced left ventricular ejection fraction (HFrEF). However, no information is available on the prognostic vale of cardiac 123I-MIBG SPECT imaging in patients with HFpEF.

METHODS:

We studied 148 patients admitted for acute decompensated HF (ADHF) with nonischemic HFpEF and who underwent cardiac 123I-MIBG imaging at discharge. The cardiac 123I-MIBG heart-to-mediastinum ratio (H/M) was measured on the delayed planar image (late H/M). SPECT analysis of the delayed image was conducted, and the tracer uptake in all 17 regions on the polar map was scored on a 5-point scale by comparison with a sex-matched normal control database. The total defect score (TDS) was calculated by summing the score of each of the 17 segments. The primary endpoint was the association between TDS and cardiac events (the composite of emergent HF hospitalization and cardiac death).

RESULTS:

During a mean follow-up period of 2.4 ± 1.6 years, 61 patients experienced cardiac events. TDS was significantly associated with cardiac events after multivariate Cox adjustment (P < 0.0001). Patients with high TDS levels had a significantly greater risk of cardiac events than those with middle or low TDS levels (63% vs 40% vs 20%, respectively; P < 0.0001; HR: 4.69; 95% CI: 2.29 to 9.61; and HR: 2.46; 95% CI: 1.14 to 5.29). C-statistic of TDS was 0.730 (95% CI: 0.651 to 0.799), which was significantly higher than that of late H/M (0.607; 95% CI: 0.524 to 0.686; P = 0.0228).

CONCLUSIONS:

Cardiac 123I-MIBG SPECT imaging provided useful prognostic information in nonischemic ADHF patients with HFpEF. (Clinical Trial: Osaka Prefectural Acute Heart Failure Syndrome Registry [OPAR]: UMIN000015246).

• Authors: Masahiro Seo, Takahisa Yamada, Shunsuke Tamaki, Tetsuya Watanabe, Takashi Morita, Yoshio Furukawa, Masato Kawasaki, Atsushi Kikuchi, Tsutomu Kawai, Jun Nakamura, Kiyomi Kayama, Masatsugu Kawahira, Takanari Kimura, Kunpei Ueda, Daisuke Sakamoto, Yasushi Sakata, Masatake Fukunami
• Journal: JACC. Cardiovascular imaging (JACC Cardiovasc Imaging) Vol. 15 Issue 4 Pg. 655-668 (04 2022) ISSN: 1876-7591 [Electronic] United States
• PMID: 34656490 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Iodine Radioisotopes
• Radiopharmaceuticals
• 3-Iodobenzylguanidine
• Iodine-123

Topics

• 3-Iodobenzylguanidine
• Heart
• Heart Failure
• Humans
• Iodine Radioisotopes
• Predictive Value of Tests
• Prognosis
• Radiopharmaceuticals
• Stroke Volume
• Tomography, Emission-Computed, Single-Photon
• Ventricular Function, Left