Assessment of I-123-mIBG and Tc-99m-tetrofosmin single-photon emission computed tomographic images for the prediction of arrhythmic events in patients with ischemic heart failure: Intermediate severity innervation defects are associated with higher arrhythmic risk
Por:
Travin, MI, Henzlova, MJ, van Eck-Smit, BLF, Jain, D, Carrio, I, Folks, RD, Garcia, EV, Jacobson, AF, Verberne, HJ
Publicada:
1 abr 2017
Resumen:
I-123-mIBG planar image heart-to-mediastinum ratios effectively risk-stratify heart failure (HF) patients. The value of single-photon emission computed tomographic (SPECT) imaging for identifying increased risk of ventricular arrhythmias is less clear. This study sought to determine if findings from simultaneous interpretation of I-123-mIBG and Tc-99m-tetrofosmin SPECT are predictive of arrhythmic events (ArEs).
I-123-mIBG SPECT images from 622 patients with ischemic HF were presented in standard displays alongside Tc-99m-tetrofosmin images. Consensus interpretations using a 17-segment model produced summed scores. Cox proportional hazards analyses related findings to adjudicated ArEs over 2 years.
471 patients had images adequate for total 17-segment scoring. There were 48 ArEs (10.2%). Neither I-123-mIBG nor Tc-99m-tetrofosmin SPECT summed scores were univariate predictors. On multivariate proportional hazards analysis, the I-123-mIBG SPECT score was independently predictive of ArEs (HR: 0.975, 95% CI 0.951-0.999, P = 0.042), but HR < 1 indicated that risk decreased with increasing score. This occurred because patients with intermediately abnormal SPECT studies had a higher likelihood of ArEs compared to patients with extensive abnormalities.
The presumption of a monotonic increase in ArE risk with increasing summed I-123-mIBG SPECT score may not be correct as ischemic HF patients with abnormalities of intermediate extent appear at highest risk.
Filiaciones:
Travin, MI:
Montefiore Med Ctr, Albert Einstein Coll Med, Dept Radiol, Div Nucl Med, 111 East 210th St, Bronx, NY 10467 USA
Henzlova, MJ:
Mt Sinai Med Ctr, New York, NY 10029 USA
van Eck-Smit, BLF:
Univ Amsterdam, Acad Med Ctr, Dept Nucl Med, Amsterdam, Netherlands
Jain, D:
New York Med Coll, Dept Med, Westchester Med Ctr, Div Cardiol, Valhalla, NY 10595 USA
Carrio, I:
Autonomous Univ Barcelona, Hosp St Pau, Dept Nucl Med, Barcelona, Spain
Folks, RD:
Emory Univ, Sch Med, Dept Radiol, Emory Univ Hosp, Atlanta, GA 30322 USA
Garcia, EV:
Emory Univ, Sch Med, Dept Radiol, Emory Univ Hosp, Atlanta, GA 30322 USA
Jacobson, AF:
Diagram Consulting, Kihei, HI USA
GE Healthcare, Kihei, HI USA
Verberne, HJ:
Univ Amsterdam, Acad Med Ctr, Dept Nucl Med, Amsterdam, Netherlands
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