Assessment of I-123-mIBG and Tc-99m-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

作者：Travin Mark I^*; Henzlova Milena J; van Eck Smit Berthe L F; Jain Diwakar; Carrio Ignasi; Folks Russell D; Garcia Ernest V; Jacobson Arnold F; Verberne Hein J

来源：Journal of Nuclear Cardiology, 2017, 24(2): 377-391.

DOI：10.1007/s12350-015-0336-8

• I-123-mIBG
• arrhythmias
• heart failure
• SPECT

I-123-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 I-123-mIBG and Tc-99m-tetrofosmin SPECT are predictive of arrhythmic events (ArEs).
I-123-mIBG SPECT images from 622 patients with ischemic HF were presented in standard displays alongside Tc-99m-tetrofosmin images. Consensus interpretations using a 17-segment model produced summed scores. Cox proportional hazards analyses related findings to adjudicated ArEs over 2 years.
471 patients had images adequate for total 17-segment scoring. There were 48 ArEs (10.2%). Neither I-123-mIBG nor Tc-99m-tetrofosmin SPECT summed scores were univariate predictors. On multivariate proportional hazards analysis, the I-123-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.
The presumption of a monotonic increase in ArE risk with increasing summed I-123-mIBG SPECT score may not be correct as ischemic HF patients with abnormalities of intermediate extent appear at highest risk.

• 出版日期2017-4