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Cardiac 123I-mIBG scintigraphy as a screening tool to optimize CRT patient selection

Session Moderated Posters 4

Speaker Derk Verschure

Congress : ICNC, Nuclear Cardiology & Cardiac CT 2019

  • Topic : imaging
  • Sub-topic : Single Photon Emission Computed Tomography (SPECT)
  • Session type : Moderated Posters
  • FP Number : 236

Authors : DO Verschure (Amsterdam,NL), HJ Verberne (Amsterdam,NL)

Authors:
DO Verschure1 , HJ Verberne2 , 1Zaans Medical Center - Amsterdam - Netherlands (The) , 2Academic Medical Center of Amsterdam, Nuclear Medicine - Amsterdam - Netherlands (The) ,

Citation:

Aim 
Cardiac resynchronization therapy (CRT) is a disease modifying therapy in patients with chronic heart failure (CHF). Eligibility for CRT is based on QRS duration and NYHA functional capacity only. However, one-third of CHF patients does not benefit from CRT. Moreover, CRT is associated with malfunction and high costs. This study evaluated whether 123I-mIBG assessed cardiac sympathetic activity could optimize CRT patient selection. 

Methods 
42 stable CHF subjects (age 65.5±8.5 years, LVEF 23±6.5%) referred for CRT-defibrillator implantation were enrolled. All subjects underwent planar 123I-mIBG scintigraphy prior to CRT implantation. Early and late heart-to-mediastinum (H/M) ratio and 123I-mIBG washout (WO) were calculated. CRT response was defined as improvement of NYHA functional class, LVEF and QRS duration after 1 year follow-up.

Results 
Response to CRT differed depending on the parameter used: i.e. improvement of NYHA functional class (n=24), LVEF (n=28) and QRS duration (n=26). Only improvement in NYHA functional class was independently predicted by  WO (p=0.003). None of the other 123I-mIBG parameters was associated with CRT response.

Conclusion 
In stable CHF cardiac 123I-mIBG WO is associated with improvement of NYHA functional class as a measure of CRT response. Therefore, cardiac 123I-mIBG scintigraphy might help to optimize CRT patient selection.

All (n=42)

Responder (n=24)

Non-responder (n=18)

P-value

Age (years)

65.5 ± 8.5

64.0 ± 8.2

67.1 ± 8.8

0.250

Male (%)

30 (71)

14 (58)

16 (89)

0.030

Ischemic heart diseae (%)

16(38)

8 (33)

8 (44)

0.475

NYHA class II/ III

28(67)/14(33)

14 (58)/10 (42)

14 (78)/4 (22)

0.195

LVEF

22.8 ± 6.5

23.5 ± 6.4

22.1 ± 6.8

0.482

QRS time (msec)

153 ± 23

156 ± 20

0.317

NT-proBNP

2215 ± 3531

1344 ± 1353

3434 ± 5082

0.080

Planar 123I-mIBG

Early H/M ratio

2.14 ± 0.41

2.12 ± 0.37

2.17 ± 0.47

0.684

Late H/M ratio

1.86 ± 0.41

1.9 ± 0.41

1.78 ± 0.41

0.263

123I-mIBG WO

12.8 ± 10.1

9.0 ± 10.3

17.8 ± 7.4

0.004

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