Prognostic Significance of Cardiac 123I-MIBG SPECT Imaging in Heart Failure Patients With Preserved Ejection Fraction,JACC: Cardiovascular Imaging

当前位置： X-MOL 学术 › JACC Cardiovasc. Imaging › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Prognostic Significance of Cardiac 123I-MIBG SPECT Imaging in Heart Failure Patients With Preserved Ejection Fraction
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2021-10-13 , DOI: 10.1016/j.jcmg.2021.08.003
Masahiro Seo ₁ , Takahisa Yamada ₁ , Shunsuke Tamaki ₁ , Tetsuya Watanabe ₁ , Takashi Morita ₁ , Yoshio Furukawa ₁ , Masato Kawasaki ₁ , Atsushi Kikuchi ₁ , Tsutomu Kawai ₁ , Jun Nakamura ₁ , Kiyomi Kayama ₁ , Masatsugu Kawahira ₁ , Takanari Kimura ₁ , Kunpei Ueda ₁ , Daisuke Sakamoto ₁ , Yasushi Sakata ₂ , Masatake Fukunami ₁

Affiliation

Objectives

The authors sought to elucidate the prognostic value of cardiac sympathetic nerve dysfunction as evaluated using iodine-123-labeled metaiodobenzylguanidine (¹²³I-MIBG) single-photon emission computed tomography (SPECT) imaging in patients with heart failure (HF) with preserved left ventricular ejection fraction (HFpEF).

Background

Cardiac sympathetic nerve dysfunction assessed by ¹²³I-MIBG imaging is associated with poor outcomes in chronic HF patients with reduced left ventricular ejection fraction (HFrEF). However, no information is available on the prognostic vale of cardiac ¹²³I-MIBG SPECT imaging in patients with HFpEF.

Methods

We studied 148 patients admitted for acute decompensated HF (ADHF) with nonischemic HFpEF and who underwent cardiac ¹²³I-MIBG imaging at discharge. The cardiac ¹²³I-MIBG heart-to-mediastinum ratio (H/M) was measured on the delayed planar image (late H/M). SPECT analysis of the delayed image was conducted, and the tracer uptake in all 17 regions on the polar map was scored on a 5-point scale by comparison with a sex-matched normal control database. The total defect score (TDS) was calculated by summing the score of each of the 17 segments. The primary endpoint was the association between TDS and cardiac events (the composite of emergent HF hospitalization and cardiac death).

Results

During a mean follow-up period of 2.4 ± 1.6 years, 61 patients experienced cardiac events. TDS was significantly associated with cardiac events after multivariate Cox adjustment (P < 0.0001). Patients with high TDS levels had a significantly greater risk of cardiac events than those with middle or low TDS levels (63% vs 40% vs 20%, respectively; P < 0.0001; HR: 4.69; 95% CI: 2.29 to 9.61; and HR: 2.46; 95% CI: 1.14 to 5.29). C-statistic of TDS was 0.730 (95% CI: 0.651 to 0.799), which was significantly higher than that of late H/M (0.607; 95% CI: 0.524 to 0.686; P = 0.0228).

Conclusions

Cardiac ¹²³I-MIBG SPECT imaging provided useful prognostic information in nonischemic ADHF patients with HFpEF. (Clinical Trial: Osaka Prefectural Acute Heart Failure Syndrome Registry [OPAR]: UMIN000015246)

中文翻译：

射血分数保留的心力衰竭患者心脏 123I-MIBG SPECT 成像的预后意义

目标

^{作者试图阐明使用碘 123 标记的间碘苄基胍 ( 123} I-MIBG) 单光子发射计算机断层扫描 (SPECT) 成像在左心室保留的心力衰竭 (HF) 患者中评估心脏交感神经功能障碍的预后价值射血分数 (HFpEF)。

背景

^通过123 I-MIBG 成像评估的心脏交感神经功能障碍与左心室射血分数 (HFrEF) 降低的慢性 HF 患者的不良预后相关。然而，没有关于 HFpEF 患者心脏¹²³ I-MIBG SPECT 成像预后价值的信息。

方法

我们研究了 148 名因急性失代偿性 HF (ADHF) 入院的非缺血性 HFpEF 患者，他们在出院时接受了心脏^{123 I-MIBG 成像。}在延迟平面图像（晚期 H/M）上测量心脏¹²³ I-MIBG 心脏与纵隔比（H/M）。对延迟图像进行了 SPECT 分析，通过与性别匹配的正常对照数据库进行比较，对极坐标图上所有 17 个区域的示踪剂摄取进行了 5 分制评分。总缺陷分数 (TDS) 是通过将 17 个片段中的每个片段的分数相加来计算的。主要终点是 TDS 与心脏事件（紧急 HF 住院和心源性死亡的复合）之间的关联。

结果

在 2.4 ± 1.6 年的平均随访期内，61 名患者发生了心脏事件。在多变量 Cox 调整后，TDS 与心脏事件显着相关（P < 0.0001）。TDS 水平高的患者发生心脏事件的风险显着高于 TDS 水平中等或低的患者（分别为 63% vs 40% vs 20%；P < 0.0001；HR：4.69；95% CI：2.29 至 9.61；和HR：2.46；95% CI：1.14 至 5.29）。TDS 的 C 统计量为 0.730（95% CI：0.651 至 0.799），显着高于晚期 H/M（0.607；95% CI：0.524 至 0.686；P = 0.0228）。