Cardiac Sympathetic Denervation Assessed With 123-Iodine Metaiodobenzylguanidine Imaging Predicts Ventricular Arrhythmias in Implantable Cardioverter-Defibrillator Patients

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:55

Article

Boogers, Mark J.^1,3  Borleffs, C. Jan Willem¹  Henneman, Maureen M.¹  van Bommel, Rutger J.¹  van Ramshorst, Jan¹  Boersma, Eric⁴  Dibbets-Schneider, Petra²  Stokkel, Marcel P.²  van der Wall, Ernst E.¹  Schalij, Martin J.¹  Bax, Jeroen J.¹ 

[1] Leiden Univ, Med Ctr, Dept Cardiol, NL-2333 ZA Leiden, Netherlands

[2] Leiden Univ, Med Ctr, Dept Nucl Med, NL-2333 ZA Leiden, Netherlands

[3] Interuniv Cardiol Inst Netherlands, Utrecht, Netherlands

[4] Erasmus Univ, Dept Epidemiol & Stat, Rotterdam, Netherlands

关键词: implantable cardioverter-defibrillator;    123-iodine metaiodobenzylguanidine imaging;    sympathetic denervation;    ventricular arrhythmias;   

DOI  :  10.1016/j.jacc.2009.12.066

来源: Elsevier

【 摘 要 】

Objectives The purpose of this study was to evaluate whether 123-iodine metaiodobenzylguanidine (123-I MIBG) imaging predicts ventricular arrhythmias causing appropriate implantable cardioverter-defibrillator (ICD) therapy (primary end point) and the composite of appropriate ICD therapy or cardiac death (secondary end point). Background Although cardiac sympathetic denervation is associated with ventricular arrhythmias, limited data are available on the predictive value of sympathetic nerve imaging with 123-I MIBG on the occurrence of arrhythmias. Methods Before ICD implantation, patients underwent 123-I MIBG and myocardial perfusion imaging. Early and late 123-I MIBG (planar and single-photon emission computed tomography [SPECT]) imaging was performed to assess cardiac innervation (heart-to-mediastinum ratio, cardiac washout rate, and 123-I MIBG SPECT defect score). Stress-rest myocardial perfusion imaging was performed to assess myocardial infarction and perfusion abnormalities (perfusion defect scores). During follow-up, appropriate ICD therapy and cardiac death were documented. Results One-hundred sixteen heart failure patients referred for ICD therapy were enrolled. During a mean follow-up of 23 +/- 15 months, appropriate ICD therapy (primary end point) was documented in 24 (21%) patients and appropriate ICD therapy or cardiac death (secondary end point) in 32 (28%) patients. Late 123-I MIBG SPECT defect score was an independent predictor for both end points. Patients with a large late 123-I MIBG SPECT defect (summed score >26) showed significantly more appropriate ICD therapy (52% vs. 5%, p < 0.01) and appropriate ICD therapy or cardiac death (57% vs. 10%, p < 0.01) than patients with a small defect (summed score <= 26) at 3-year follow-up. Conclusions Cardiac sympathetic denervation predicts ventricular arrhythmias causing appropriate ICD therapy as well as the composite of appropriate ICD therapy or cardiac death. (J Am Coll Cardiol 2010; 55: 2769-77) (C) 2010 by the American College of Cardiology Foundation

【 授权许可】

Free