Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russian Federation.
J Nucl Cardiol. 2022 Apr;29(2):680-691. doi: 10.1007/s12350-020-02321-y. Epub 2020 Aug 26.
Previous studies show inconsistent results on the role of innervation imaging (with I-123-mIBG) and perfusion imaging in predicting appropriate ICD therapy (aICDth). These studies included patients with both dilated and ischemic cardiomyopathy. This study compared the ability of I-mIBG imaging along with perfusion imaging (using thallium-199) to predict aICDth in patients with ischemic heart failure (IHF) in relation to indication for ICD implantation (primary vs. secondary prevention of sudden cardiac death (SCD)).
mIBG/thallium SPECT imaging were performed before ICD implantation in 80 patients with IHF: 49 candidates for primary and 31 for secondary SCD prevention.
During a mean follow-up of 18 months, the imaging results could not predict patients with appropriate ICD therapy among patients with ICD implants for primary SCD prevention. While in the secondary SCD prevention group, those who received a ICDth had significantly larger summed scores of regional perfusion and innervation impairment, but not higher heart-to-mediastinal mIBG ratio. The best results to predict aICDth were using mIBG summed score (cut-off point > 34%, sensitivity 72%, specificity 100%, AUC 0.909, P < 0.0001).
The prognostic value of innervation and perfusion imaging in patients with IHF differ based on indication for ICD implantation (primary vs. secondary prevention of SCD).
先前的研究表明，在预测适当的 ICD 治疗（aICDth）方面，神经成像（使用 I-123-mIBG）和灌注成像的作用结果不一致。这些研究包括扩张型和缺血性心肌病患者。本研究比较了 I-mIBG 成像与灌注成像（使用铊-199）在缺血性心力衰竭（IHF）患者中的作用，以评估其与 ICD 植入指征（心脏性猝死（SCD）的一级预防与二级预防）的关系，以预测 aICDth。
在 80 例 IHF 患者植入 ICD 前进行 mIBG/铊 SPECT 成像：49 例为一级预防，31 例为二级预防 SCD。
在平均 18 个月的随访中，成像结果无法预测一级预防 SCD 的 ICD 植入患者中的适当 ICD 治疗患者。而在二级预防 SCD 组中，那些接受 ICDth 的患者的区域灌注和神经支配损伤的总和评分显著更高，但心脏与纵隔间 mIBG 比值没有更高。预测 aICDth 的最佳结果是使用 mIBG 总和评分（截断值>34%，灵敏度 72%，特异性 100%，AUC 0.909，P<0.0001）。
在 IHF 患者中，神经和灌注成像的预后价值根据 ICD 植入的指征（一级预防与二级预防 SCD）而不同。
