University of Illinois College of Medicine Rockford, Rockford, IL, USA.
Curr Cardiol Rep. 2012 Apr;14(2):200-7. doi: 10.1007/s11886-012-0249-y.
A novel indication for (123)I-mIBG has recently been proposed to risk stratify patients with atrial fibrillation. This review puts into perspective the utility and importance of such a risk stratification modality, in the setting of the epidemic of atrial fibrillation, which also relates to the prevalence of heart failure, obesity, hypertension, and stroke. The authors argue that the epic cost of care for patients with paroxysmal and more advanced forms of atrial fibrillation-including catheter ablation, heart failure, and stroke management-coupled with the poor efficacy of all treatment modalities in advanced atrial fibrillation, make necessary a paradigm shift where only paroxysmal atrial fibrillation that demonstrably will turn into permanent fibrillation should be targeted aggressively. If this premise is accepted, then (123)I-mIBG nuclear imaging for risk stratification becomes a vital tool for the care of the individual patient, as well as for disease control and cost containment in the population, since (123)I-mIBG scanning alone can predict (with hazard ratios of the order of 3.0-5.0) the future occurrence of permanent atrial fibrillation or heart failure.
最近提出了一种（123）I-mIBG 的新适应症，用于对心房颤动患者进行风险分层。在心房颤动流行的背景下，这种风险分层方法的实用性和重要性得到了充分体现，心房颤动也与心力衰竭、肥胖、高血压和中风的患病率有关。作者认为，阵发性和更严重形式的心房颤动患者的治疗费用高昂，包括导管消融、心力衰竭和中风管理，再加上所有治疗方法在晚期心房颤动中的疗效不佳，这使得我们必须转变观念，只有明确会转为永久性房颤的阵发性房颤才应积极治疗。如果接受这一前提，那么（123）I-mIBG 核素成像进行风险分层就成为个体患者治疗以及人群疾病控制和成本控制的重要工具，因为（123）I-mIBG 扫描本身就可以预测永久性房颤或心力衰竭的未来发生（风险比约为 3.0-5.0）。
