Verschure Derk O, Nakajima Kenichi, Verberne Hein J
Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, 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.
Pharmaceuticals (Basel). 2022 May 25;15(6):656. doi: 10.3390/ph15060656.
Cardiac sympathetic upregulation is one of the neurohormonal compensation mechanisms that play an important role in the pathogenesis of chronic heart failure (CHF). In the past decades, cardiac I-IBG scintigraphy has been established as a feasible technique to evaluate the global and regional cardiac sympathetic innervation. Although cardiac I-IBG imaging has been studied in many cardiac and neurological diseases, it has extensively been studied in ischemic and non-ischemic CHF. Therefore, this review will focus on the role of I-IBG imaging in CHF. This non-invasive, widely available technique has been established to evaluate the prognosis in CHF. Standardization, especially among various combinations of gamma camera and collimator, is important for identifying appropriate thresholds for adequate risk stratification. Interestingly, in contrast to the linear relationship between I-IBG-derived parameters and overall prognosis, there seems to be a "bell-shape" curve for I-IBG-derived parameters in relation to ventricular arrhythmia or appropriate implantable cardioverter defibrillator (ICD) therapy in patients with ischemic CHF. In addition, there is a potential clinical role for cardiac I-IBG imaging in optimizing patient selection for implantation of expensive devices such as ICD and cardiac resynchronization therapy (CRT). Based on cardiac I-IBG data risk models and machine learning, models have been developed for appropriate risk assessment in CHF.
心脏交感神经上调是神经激素代偿机制之一，在慢性心力衰竭（CHF）的发病机制中起重要作用。在过去几十年中，心脏碘-间位碘代苄胍（I-IBG）闪烁扫描已成为评估整体和局部心脏交感神经支配的一种可行技术。尽管心脏I-IBG成像已在许多心脏和神经疾病中得到研究，但在缺血性和非缺血性CHF中已有广泛研究。因此，本综述将聚焦于I-IBG成像在CHF中的作用。这种非侵入性、广泛可用的技术已被用于评估CHF的预后。标准化，尤其是在γ相机和准直器的各种组合之间，对于确定适当的风险分层阈值很重要。有趣的是，与I-IBG衍生参数与总体预后之间的线性关系不同，在缺血性CHF患者中，I-IBG衍生参数与室性心律失常或合适的植入式心律转复除颤器（ICD）治疗之间似乎存在“钟形”曲线。此外，心脏I-IBG成像在优化昂贵设备（如ICD和心脏再同步治疗（CRT））植入的患者选择方面具有潜在的临床作用。基于心脏I-IBG数据风险模型和机器学习，已开发出用于CHF中适当风险评估的模型。
