Format

Send to

Choose Destination
Rev Esp Med Nucl Imagen Mol. 2016 Mar-Apr;35(2):74-80. doi: 10.1016/j.remn.2015.08.002. Epub 2015 Oct 26.

Cardiac sympathetic innervation assessed with (123)I-MIBG retains prognostic utility in diabetic patients with severe left ventricular dysfunction evaluated for primary prevention implantable cardioverter-defibrillator.

Author information

1
Cardiac Imaging Unit, ERESA, Consorcio Hospital General Universitario de Valencia, Valencia, Spain. Electronic address: mpgarcia@eresa.com.
2
Department of Cardiology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
3
Department of Nuclear Medicine ERESA, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
4
Cardiac Imaging Unit, ERESA, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
5
Department of Cardiology, Hospital Marina Salud, Denia, Spain.
6
Department of Cardiology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain; Department of Medicine, Universitat de Valencia, Valencia, Spain.

Abstract

BACKGROUND:

Scintigraphy with iodine-123-metaiodobenzylguanidine ((123)I-MIBG) is a non-invasive tool for the assessment of cardiac sympathetic innervation (CSI) that has proven to be an independent predictor of survival. Recent studies have shown that diabetic patients with heart failure (HF) have a higher deterioration in CSI. It is unknown if (123)I-MIBG has the same predictive value for diabetic and non-diabetic patients with advanced HF. An analysis is performed to determine whether CSI with (123)I-MIBG retains prognostic utility in diabetic patients with HF, evaluated for a primary prevention implantable cardioverter-defibrillator (ICD).

MATERIAL AND METHODS:

Seventy-eight consecutive HF patients (48 diabetic) evaluated for primary prevention ICD implantation were prospectively enrolled and underwent (123)I-MIBG to assess CSI (heart-to-mediastinum ratio - HMR). A Cox proportional hazards multivariate analysis was used to determine the influence of (123)I-MIBG images for prediction of cardiac events in both diabetic and non-diabetic patients. The primary end-point was a composite of arrhythmic event, cardiac death, or admission due to HF.

RESULTS:

During a mean follow-up of 19.5 [9.3-29.3] months, the primary end-point occurred in 24 (31%) patients. Late HMR was significantly lower in diabetic patients (1.30 vs. 1.41, p=0.014). Late HMR≤1.30 was an independent predictor of cardiac events in diabetic (hazard ratio 4.53; p=0.012) and non-diabetic patients (hazard ratio 12.31; p=0.023).

CONCLUSIONS:

Diabetic patients with HF evaluated for primary prevention ICD show a higher deterioration in CSI than non-diabetics; nevertheless (123)I-MIBG imaging retained prognostic utility for both diabetic and non-diabetic patients.

KEYWORDS:

Diabetes mellitus; Heart failure; Insuficiencia cardiaca; MIBG; Prognosis; Pronóstico; Sistema nervioso simpático; Sympathetic nervous system

PMID:
26514320
DOI:
10.1016/j.remn.2015.08.002
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center