The relation between cardiac 123I-mIBG scintigraphy and functional response 1 year after CRT implantation. (7th April 2020)

• Record Type: Journal Article
• Authors: Verschure, D O; Poel, E; De Vincentis, G; Frantellizzi, V; Nakajima, K; Gheysens, O; de Groot, J R; Verberne, H J
• Is Part Of: European heart journal. Volume 22:Number 1(2021)
• Page Start: 49
• Page End: 57
• Publication Date: 2020-04-07
• Subjects: chronic heart failure -- cardiac resynchronization therapy -- response -- 123I-mIBG scintigraphy -- heart-to-mediastinum ratio -- wash out; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeaa045
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims : Cardiac resynchronization therapy (CRT) is a disease-modifying therapy in patients with chronic heart failure (CHF). Current guidelines ascribe CRT eligibility on three parameters only: left ventricular ejection fraction (LVEF), QRS duration, and New York Heart Association (NYHA) functional class. However, one-third of CHF patients does not benefit from CRT. This study evaluated whether 123 I- meta -iodobenzylguanidine ( 123 I- m IBG) assessed cardiac sympathetic activity could optimize CRT patient selection. Methods and results : A total of 78 stable CHF subjects (age 66.8 ± 9.6 years, 73% male, LVEF 25.2 ± 6.7%, QRS duration 153 ± 23 ms, NYHA 2.2 ± 0.7) referred for CRT implantation were enrolled. Subjects underwent 123 I- m IBG scintigraphy prior to implantation. Early and late heart-to-mediastinum (H/M) ratio and 123 I- m IBG washout were calculated. CRT response was defined as either an increase of LVEF to >35%, any improvement in LVEF of >10%, QRS shortening to <150 ms, or improvement in NYHA class of >1 class. In 33 patients LVEF increased to >35%, QRS decreased <150 ms in 36 patients, and NYHA class decreased in 33 patients. Late H/M ratio and hypertension were independent predictors of LVEF improvement to >35% ( P = 0.0014 and P = 0.0149, respectively). In addition, early H/M ratio, LVEF, and absence of diabetes mellitus (DM) were independent predictors for LVEF improvement by >10%. No independent predictors were found for QRS shortening to <150 ms or improvement in NYHA class. Conclusion : Early and late H/M ratio were independent predictors of CRT response when improvement of LVEF was used as measure of response. Therefore, cardiac 123 I- m IBG scintigraphy may be used as a tool to optimize selection of subjects that might benefit from CRT.