I-123-mIBG myocardial imaging for assessment of risk for a major cardiac event in heart failure patients: Insights from a retrospective European multicenter study

Denis Agostini, Hein J. Verberne, Wolfgang Burchert, Juhani Knuuti, Pavol Povinec, Gianmario Sambuceti, Mustafa Unlu, Montserrat Estorch, Gopa Banerjee, Arnold F. Jacobson

Research output: Contribution to journalArticle

Abstract

Purpose: Single-center experiences have shown that myocardial meta-iodobenzylguanidine (mIBG) uptake has prognostic value in heart failure (HF) patients. To verify these observations using a rigorous clinical trial methodology, a retrospective review and prospective quantitative reanalysis was performed on a series of cardiac 123I-mIBG scans acquired during a 10-year period at six centers in Europe. Methods: 123I-mIBG scans obtained on 290 HF patients [(262 with left ventricular ejection fraction (LVEF) <50%)] from 1993 to 2002 were reanalyzed using a standardized methodology to determine the heart-to-mediastinum ratio (H/M) on delayed planar images. All image results were verified by three independent reviewers. Major cardiac events [MCEs; cardiac death, cardiac transplant, potentially fatal arrhythmia (including implantable cardioverter-defibrillator discharge)] during 24-month follow-up were confirmed by an adjudication committee. Results: MCEs occurred in 67 patients (26%): mean H/M ratio was 1.51 ± 0.30 for the MCE group and 1.97 ± 0.54 for the non-MCE group (p <0.001). Two-year event-free survival using an optimum H/M ratio threshold of 1.75 was 62% for H/M ratio less than 1.75, 95% for H/M ratio greater than or equal to 1.75 (p <0.0001). Logistic regression showed H/M ratio and LVEF as the only significant predictors of MCE. Using the lower and upper H/M quartiles of 1.45 and 2.17 as high- and very low-risk thresholds, 2-year event-free survival rates were 52% and 98%, respectively. Among patients with LVEF ≤ 35% and H/M ≥ 1.75 (n = 73), there were nine MCEs because of progressive HF and only one because of an arrhythmia. Conclusion: Application of a clinical trial methodology via the retrospective reanalysis of 123I-mIBG images confirms the previously reported prognostic value of this method in HF patients, including potential identification of a quantitative threshold for low risk for cardiac mortality and potentially fatal ventricular arrhythmias.

Original languageEnglish
Pages (from-to)535-546
Number of pages12
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume35
Issue number3
DOIs
Publication statusPublished - Mar 2008

Keywords

  • Cardiology
  • mIBG
  • Nuclear imaging
  • Prognosis
  • Scintigraphy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

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