Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, theNetherlands.
Department of Cardiology, Zaans Medical Center, Koningin Julianaplein 58, 1502DV, Zaandam, theNetherlands.
Eur Heart J Cardiovasc Imaging. 2022 Aug 22;23(9):1201-1209. doi: 10.1093/ehjci/jeab132.
Cardiac 123iodine-meta-iodobenzylguanidine (123I-mIBG) single-photon emission computed tomography (SPECT) imaging provides information on regional myocardial innervation. However, the value of the commonly used 17-segment summed defect score (SDS) as a prognostic marker is uncertain. The present study examined whether a simpler regional scoring approach for evaluation of 123I-mIBG SPECT combined with rest 99mTc-tetrofosmin SPECT myocardial perfusion imaging could improve prediction of arrhythmic events (AEs) in patients with ischaemic heart failure (HF).
Five hundred and two ischaemic HF subjects of the ADMIRE-HF study with complete cardiac 123I-mIBG and rest 99mTc-tetrofosmin SPECT studies were included. Both SPECT image sets were read together by two experienced nuclear imagers and scored by consensus. In addition to standard 17-segment scoring, the readers classified walls (i.e. anterior, lateral, inferior, septum and apex) as normal, matched defect, mismatched (innervation defect > perfusion defect), or reverse mismatched (perfusion defect > innervation defect). Cox proportional hazards ratios (HRs) were used to determine if age, body mass index, functional class, left ventricular ejection fraction (LVEF), B-type natriuretic peptide (BNP), norepinephrine, 123I-mIBG SDS, 99mTc-tetrofosmin SDS, innervation/perfusion mismatch SDS, and our simplified visual innervation/perfusion wall classification were associated with occurrence of AEs (i.e. sudden cardiac death, sustained ventricular tachycardia, resuscitated cardiac arrest, appropriate implantable cardioverter-defibrillator therapy). At 2-year median follow-up, 52 subjects (10.4%) had AEs. Subjects with 1 or 2 mismatched walls were twice as likely to have AEs compared with subjects with either 0 or 3-5 mismatched walls (16.3% vs. 8.3%, P = 0.010). Cox regression analyses showed that patients with a visual mismatch in 1-2 walls had an almost two times higher risk of AEs [HR 2.084 (1.109-3.914), P = 0.001]. None of the other innervation, perfusion and mismatch scores using standard 17 segments were associated with AEs. BNP (ng/L) was the only non-imaging parameter associated with AEs.
A visual left ventricular wall-level based scoring method identified highest AE risk in ischaemic HF subjects with intermediate levels of innervation/perfusion mismatches. This simple technique for the evaluation of SPECT studies, which are often challenging in HF subjects, seems to be superior to the 17-segment scoring method.
心脏 123 碘-间碘苄胍（123I-mIBG）单光子发射计算机断层扫描（SPECT）成像可提供有关局部心肌神经支配的信息。然而，常用的 17 节段总和缺陷评分（SDS）作为预后标志物的价值尚不确定。本研究探讨了一种更简单的区域评分方法，用于评估 123I-mIBG SPECT 与静息 99mTc-四氮甲基替罗非明 SPECT 心肌灌注成像的结合，是否可以改善缺血性心力衰竭（HF）患者心律失常事件（AE）的预测。
ADMIRE-HF 研究中纳入了 502 例缺血性 HF 患者，他们均接受了完整的心脏 123I-mIBG 和静息 99mTc-四氮甲基替罗非明 SPECT 研究。两名有经验的核成像专家共同阅读这两种 SPECT 图像集并达成共识进行评分。除了标准的 17 节段评分外，读者还将壁（即前壁、侧壁、下壁、间隔和心尖）分类为正常、匹配缺陷、不匹配（神经支配缺陷>灌注缺陷）或反向不匹配（灌注缺陷>神经支配缺陷）。使用 Cox 比例风险比（HRs）确定年龄、体重指数、功能分级、左心室射血分数（LVEF）、B 型利钠肽（BNP）、去甲肾上腺素、123I-mIBG SDS、99mTc-四氮甲基替罗非明 SDS、神经支配/灌注不匹配 SDS 以及我们的简化视觉神经支配/灌注壁分类是否与 AE（即心脏性猝死、持续性室性心动过速、复苏性心脏骤停、适当的植入式心脏复律除颤器治疗）的发生相关。在 2 年的中位随访期间，52 例（10.4%）患者发生 AE。与 0 或 3-5 个不匹配壁的患者相比，1 或 2 个不匹配壁的患者发生 AE 的可能性是其两倍（16.3% vs. 8.3%，P=0.010）。Cox 回归分析显示，1-2 个壁存在视觉不匹配的患者发生 AE 的风险几乎高出两倍[风险比 2.084（1.109-3.914），P=0.001]。使用标准的 17 个节段的其他神经支配、灌注和不匹配评分均与 AE 无关。BNP（ng/L）是唯一与 AE 相关的非影像学参数。
基于视觉左心室壁水平的评分方法可识别出存在中等程度神经支配/灌注不匹配的缺血性 HF 患者中的最高 AE 风险。这种用于评估 SPECT 研究的简单技术（在 HF 患者中经常具有挑战性）似乎优于 17 节段评分方法。
