Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
J Am Coll Cardiol. 2010 Jun 15;55(24):2769-77. doi: 10.1016/j.jacc.2009.12.066.
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).
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.
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.
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.
Cardiac sympathetic denervation predicts ventricular arrhythmias causing appropriate ICD therapy as well as the composite of appropriate ICD therapy or cardiac death.
本研究旨在评估 123-碘代间位碘苄胍（123-I MIBG）成像是否可预测导致恰当植入式心脏复律除颤器（ICD）治疗的室性心律失常（主要终点）以及恰当 ICD 治疗或心脏性死亡的复合终点（次要终点）。
尽管心脏交感神经去神经支配与室性心律失常有关，但有关 123-I MIBG 交感神经成像对心律失常发生的预测价值的数据有限。
在植入 ICD 之前，患者接受了 123-I MIBG 和心肌灌注成像检查。进行早期和晚期 123-I MIBG（平面和单光子发射计算机断层扫描[SPECT]）成像，以评估心脏神经支配（心脏与纵隔比、心脏清除率和 123-I MIBG SPECT 缺损评分）。进行应激-静息心肌灌注成像以评估心肌梗死和灌注异常（灌注缺损评分）。在随访期间，记录了恰当的 ICD 治疗和心脏性死亡。
共纳入了 116 例因 ICD 治疗而转诊的心力衰竭患者。在平均 23±15 个月的随访期间，24 例（21%）患者记录到恰当的 ICD 治疗（主要终点），32 例（28%）患者记录到恰当的 ICD 治疗或心脏性死亡（次要终点）。晚期 123-I MIBG SPECT 缺损评分是两个终点的独立预测因素。晚期 123-I MIBG SPECT 缺损较大（总和评分>26）的患者在 3 年随访时更易发生恰当的 ICD 治疗（52% vs. 5%，p<0.01）和恰当的 ICD 治疗或心脏性死亡（57% vs. 10%，p<0.01），而缺损较小（总和评分≤26）的患者发生率较低。
心脏交感神经去神经支配可预测导致恰当 ICD 治疗的室性心律失常以及恰当 ICD 治疗或心脏性死亡的复合终点。
