Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Department of Cardiology, Zaans Medical Center, Koningin Julianaplein 58, 1502 DV Zaandam, the Netherlands.
Eur Heart J Cardiovasc Imaging. 2021 Jan 1;22(1):49-57. doi: 10.1093/ehjci/jeaa045.
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 123I-meta-iodobenzylguanidine (123I-mIBG) assessed cardiac sympathetic activity could optimize CRT patient selection.
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 123I-mIBG scintigraphy prior to implantation. Early and late heart-to-mediastinum (H/M) ratio and 123I-mIBG 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.
Early and late H/M ratio were independent predictors of CRT response when improvement of LVEF was used as measure of response. Therefore, cardiac 123I-mIBG scintigraphy may be used as a tool to optimize selection of subjects that might benefit from CRT.
心脏再同步治疗（CRT）是慢性心力衰竭（CHF）患者的一种疾病修正治疗方法。目前的指南仅根据三个参数来确定 CRT 的适应证：左心室射血分数（LVEF）、QRS 持续时间和纽约心脏协会（NYHA）功能分级。然而，三分之一的 CHF 患者不能从 CRT 中获益。本研究评估了心脏去甲肾上腺素摄取 123I-间碘苄胍（123I-mIBG）评估心脏交感神经活性是否可以优化 CRT 患者的选择。
共纳入 78 例稳定的 CHF 患者（年龄 66.8±9.6 岁，73%为男性，LVEF 25.2±6.7%，QRS 持续时间 153±23ms，NYHA 2.2±0.7），这些患者因 CRT 植入而被转诊。所有患者在植入前均行 123I-mIBG 闪烁显像。计算早期和晚期心脏与纵隔（H/M）比值和 123I-mIBG 洗脱率。CRT 反应定义为 LVEF 增加>35%，LVEF 增加>10%，QRS 缩短至<150ms，或 NYHA 分级改善>1 级。33 例患者 LVEF 增加>35%，36 例患者 QRS 缩短<150ms，33 例患者 NYHA 分级降低。晚期 H/M 比值和高血压是 LVEF 增加>35%的独立预测因素（P=0.0014 和 P=0.0149）。此外，早期 H/M 比值、LVEF 和无糖尿病（DM）是 LVEF 增加>10%的独立预测因素。对于 QRS 缩短至<150ms 或 NYHA 分级改善，没有发现独立的预测因素。
当以 LVEF 的改善作为 CRT 反应的衡量标准时，早期和晚期 H/M 比值是 CRT 反应的独立预测因素。因此，心脏 123I-mIBG 闪烁显像可作为一种工具，用于优化可能从 CRT 中获益的患者的选择。
