Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Zaans Medical Center, Zaandam, The Netherlands.
Heart Center, Department of Cardiology Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Int J Cardiol. 2017 Dec 1;248:403-408. doi: 10.1016/j.ijcard.2017.08.003. Epub 2017 Aug 25.
Chronic heart failure (CHF) is a life-threatening clinical syndrome, partly due to sudden cardiac death (SCD). Implantable cardioverter defibrillators (ICD) for primary prevention of SCD have improved overall survival of CHF patients. However, a high percentage of patients never receives appropriate ICD therapy. This prospective multicentre study evaluated whether cardiac sympathetic activity assessed by I-mIBG scintigraphy could be helpful in selecting patients for ICD implantation.
135 stable CHF subjects (age 64.5±9.3years, 79% male, LVEF 25±6%) referred for prophylactic ICD implantation were enrolled in 13 institutions. All subjects underwent planar and SPECT I-mIBG scintigraphy. Early and late heart-to-mediastinum (H/M) ratio, I-mIBG washout (WO) and late summed scores were calculated. The primary endpoint was appropriate ICD therapy. The secondary endpoint was defined as the combined endpoint of all first cardiac events: appropriate ICD therapy, progression of heart failure (HF) and cardiac death.
During a median follow-up of 30months (6-68months), 24 subjects (17.8%) experienced a first cardiac event (appropriate ICD therapy [12], HF progression [6], cardiac death [6]). Late H/M ratio and defect size of I-mIBG SPECT were not associated with appropriate ICD therapy. However, late H/M ratio was independently associated with the combined endpoint (HR 0.135 [0.035-0.517], p=0.001). Post-hoc analysis showed that the combination of late H/M ratio (HR 0.461 [0.281-0.757]) and LVEF (HR 1.052 [1.021-1.084]) was significantly associated with freedom of appropriate ICD therapy (p<0.001).
I-mIBG scintigraphy seems to be helpful in selecting CHF subjects who might not benefit from ICD implantation.
慢性心力衰竭（CHF）是一种危及生命的临床综合征，部分原因是心源性猝死（SCD）。植入式心脏复律除颤器（ICD）用于预防 SCD 可改善 CHF 患者的总体生存率。然而，仍有很大比例的患者从未接受过适当的 ICD 治疗。这项前瞻性多中心研究评估了心脏交感神经活性的评估是否有助于选择患者进行 ICD 植入。
135 名稳定的 CHF 患者（年龄 64.5±9.3 岁，79%为男性，LVEF 25±6%）因预防性 ICD 植入而被纳入 13 家机构。所有患者均接受平面和 SPECT I-mIBG 闪烁显像。计算早期和晚期心脏与纵隔（H/M）比值、I-mIBG 洗脱（WO）和晚期总和评分。主要终点是适当的 ICD 治疗。次要终点定义为所有首次心脏事件的综合终点：适当的 ICD 治疗、心力衰竭（HF）进展和心脏死亡。
在中位随访 30 个月（6-68 个月）期间，24 名患者（17.8%）经历了首次心脏事件（适当的 ICD 治疗[12]，HF 进展[6]，心脏死亡[6]）。晚期 H/M 比值和 I-mIBG SPECT 缺损大小与适当的 ICD 治疗无关。然而，晚期 H/M 比值与复合终点独立相关（HR 0.135 [0.035-0.517]，p=0.001）。事后分析显示，晚期 H/M 比值（HR 0.461 [0.281-0.757]）和 LVEF（HR 1.052 [1.021-1.084]）的组合与适当 ICD 治疗的无事件自由显著相关（p<0.001）。
I-mIBG 闪烁显像似乎有助于选择可能从 ICD 植入中获益不大的 CHF 患者。
