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Open Access 01-05-2013 | Nuclear Cardiology (V Dilsizian, Section Editor)

The Potential Role of Iodine-123 Metaiodobenzylguanidine Imaging for Identifying Sustained Ventricular Tachycardia in Patients with Cardiomyopathy

Authors: Thomas Klein, Vasken Dilsizian, Qi Cao, Wengen Chen, Timm-Michael Dickfeld

Published in: Current Cardiology Reports | Issue 5/2013

Abstract

Implantable cardioverter-defibrillators (ICDs) significantly reduce mortality in patients with depressed left ventricular ejection fraction (LVEF) and heart failure (HF). However, shortcomings of LVEF to accurately identify those at greatest risk of ventricular tachyarrhythmias have led to the pursuit of alternative means to refine qualification criteria for ICD implantation. It is well established that imaging the cardiac nervous system with¹²³I meta-iodobenzylguanidine (¹²³I-mIBG) provides incremental prognostic value in patients with HF beyond LVEF. Whether ¹²³I-mIBG will also play an important role for identifying and/or predicting sustained ventricular tachyarrhythmias in patients with cardiomyopathy and determining those who may benefit from ICD implantation is currently under investigation. Novel imaging approaches that pinpoint the site of ventricular arrhythmias and guide ventricular tachycardia ablation are presented.

Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation. 2001;104:2158–63.PubMedCrossRef

Chugh SS, Jui J, Gunson K, et al. Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community. J Am Coll Cardiol. 2004;44:1268–75.PubMedCrossRef

Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–83.PubMedCrossRef

Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–37.PubMedCrossRef

Myerburg RJ, Interian Jr A, Mitrani RM, Kessler KM, Castellanos A. Frequency of sudden cardiac death and profiles of risk. Am J Cardiol. 1997;80:10F–9F.PubMedCrossRef

Myerburg RJ, Mitrani R, Interian Jr A, Castellanos A. Interpretation of outcomes of antiarrhythmic clinical trials: design features and population impact. Circulation. 1998;97:1514–21.PubMedCrossRef

Moss AJ, Greenberg H, Case RB, Zareba W, Hall WJ, Brown MW, et al. Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation. 2004;110:3760–5.PubMedCrossRef

Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114:e385–484.PubMedCrossRef

Raffel DM, Wieland DM. Development of mIBG as a cardiac innervation imaging agent. JACC Cardiovasc Imaging. 2010;3:111–6.PubMedCrossRef

10.

Dae MW, De Marco T, Botvinick EH, et al. Scintigraphic assessment of MIBG uptake in globally denervated human and canine hearts–implications for clinical studies. J Nucl Med. 1992;33:1444–50.PubMed

11.

Flotats A, Carrio I, Agostini D, et al. Proposal for standardization of 123I-metaiodobenzylguanidine (MIBG) cardiac sympathetic imaging by the EANM Cardiovascular Committee and the European Council of Nuclear Cardiology. Eur J Nucl Med Mol Imaging. 2010;37:1802–12.PubMedCrossRef

12.

Veltman CE, Boogers MJ, Meinardi JE, et al. Reproducibility of planar (123)I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy in patients with heart failure. Eur J Nucl Med Mol Imaging. 2012;39:1599–608.PubMedCrossRef

13.

Chen W, Cao Q, Dilsizian V. Variation of heart-to-mediastinal ratio in (123)I-mIBG cardiac sympathetic imaging: its affecting factors and potential corrections. Curr Cardiol Rep. 2011;13:132–7.PubMedCrossRef

14.

Tsuchimochi S, Tamaki N, Tadamura E, et al. Age and gender differences in normal myocardial adrenergic neuronal function evaluated by iodine-123-MIBG imaging. J Nucl Med. 1995;36:969–74.PubMed

15.

Cohn JN, Levine TB, Olivari MT, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med. 1984;311:819–23.PubMedCrossRef

16.

Brophy JM, Joseph L, Rouleau JL. Beta-blockers in congestive heart failure. A Bayesian meta-analysis. Ann Intern Med. 2001;134:550–60.PubMedCrossRef

17.

Foody JM, Farrell MH, Krumholz HM. beta-Blocker therapy in heart failure: scientific review. JAMA. 2002;287:883–9.PubMedCrossRef

18.

Merlet P, Valette H, Dubois-Rande JL, et al. Prognostic value of cardiac metaiodobenzylguanidine imaging in patients with heart failure. J Nucl Med. 1992;33:471–7.PubMed

19.

Nakata T, Wakabayashi T, Kyuma M, Takahashi T, Tsuchihashi K, Shimamoto K. Cardiac metaiodobenzylguanidine activity can predict the long-term efficacy of angiotensin-converting enzyme inhibitors and/or beta-adrenoceptor blockers in patients with heart failure. Eur J Nucl Med Mol Imaging. 2005;32:186–94.PubMedCrossRef

20.

Cohen-Solal A, Esanu Y, Logeart D, et al. Cardiac metaiodobenzylguanidine uptake in patients with moderate chronic heart failure: relationship with peak oxygen uptake and prognosis. J Am Coll Cardiol. 1999;33:759–66.PubMedCrossRef

21.

Yamada T, Shimonagata T, Fukunami M, et al. Comparison of the prognostic value of cardiac iodine-123 metaiodobenzylguanidine imaging and heart rate variability in patients with chronic heart failure: a prospective study. J Am Coll Cardiol. 2003;41:231–8.PubMedCrossRef

22.

Agostini D, Verberne HJ, Burchert W, et al. I-123-mIBG myocardial imaging for assessment of risk for a major cardiac event in heart failure patients: insights from a retrospective European multicenter study. Eur J Nucl Med Mol Imaging. 2008;35:535–46.PubMedCrossRef

23.

Imamura Y, Fukuyama T, Mochizuki T, Miyagawa M, Watanabe K, Ehime MIBG. Heart Failure Study Investigators. Prognostic value of iodine-123-metaiodobenzylguanidine imaging and cardiac natriuretic peptide levels in patients with left ventricular dysfunction resulting from cardiomyopathy. Jpn Circ J. 2001;65:155–60.PubMedCrossRef

24.

Merlet P, Benvenuti C, Moyse D, et al. Prognostic value of MIBG imaging in idiopathic dilated cardiomyopathy. J Nucl Med. 1999;40:917–23.PubMed

25.

Ogita H, Shimonagata T, Fukunami M, et al. Prognostic significance of cardiac (123)I metaiodobenzylguanidine imaging for mortality and morbidity in patients with chronic heart failure: a prospective study. Heart. 2001;86:656–60.PubMedCrossRef

26.

Gerson MC, Craft LL, McGuire N, Suresh DP, Abraham WT, Wagoner LE. Carvedilol improves left ventricular function in heart failure patients with idiopathic dilated cardiomyopathy and a wide range of sympathetic nervous system function as measured by iodine 123 metaiodobenzylguanidine. J Nucl Cardiol. 2002;9:608–15.PubMedCrossRef

27.

Erol-Yilmaz A, Verberne HJ, Schrama TA, et al. Cardiac resynchronization induces favorable neurohumoral changes. Pacing Clin Electrophysiol. 2005;28:304–10.PubMedCrossRef

28.

Gould PA, Kong G, Kalff V, et al. Improvement in cardiac adrenergic function post biventricular pacing for heart failure. Europace. 2007;9:751–6.PubMedCrossRef

29.

Drakos SG, Athanasoulis T, Malliaras KG, et al. Myocardial sympathetic innervation and long-term left ventricular mechanical unloading. JACC Cardiovasc Imaging. 2010;3:64–70.PubMedCrossRef

30.

Burri H, Sunthorn H, Somsen A, et al. Improvement in cardiac sympathetic nerve activity in responders to resynchronization therapy. Europace. 2008;10:374–8.PubMedCrossRef

31.

Nishioka SA, MartinelliFilho M, Brandao SC, et al. Cardiac sympathetic activity pre and post resynchronization therapy evaluated by 123I-MIBG myocardial scintigraphy. J Nucl Cardiol. 2007;14:852–9.PubMedCrossRef

32.

Verberne HJ, Brewster LM, Somsen GA, van Eck-Smit BL. Prognostic value of myocardial 123I-metaiodobenzylguanidine (MIBG) parameters in patients with heart failure: a systematic review. Eur Heart J. 2008;29:1147–59.PubMedCrossRef

33.

Dilsizian V, Chandrashekhar Y, Narula J. Introduction of new tests: low are the mountains, high the expectations. JACC Cardiovasc Imaging. 2010;3:117–9.PubMedCrossRef

34.

•• Jacobson AF, Senior R, Cerqueira MD, et al. Myocardial iodine-123 meta-iodobenzylguanidine imaging and cardiac events in heart failure. Results of the prospective ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) study. J Am Coll Cardiol. 2010;55:2212–21. This multicenter, prospective study on 961 patients from 96 sites provided validation of the independent prognostic value of H/M in assessing heart failure patients.PubMedCrossRef

35.

Nakata T, Miyamoto K, Doi A, Sasao H, Wakabayashi T, Kobayashi H, et al. Cardiac death prediction and impaired cardiac sympathetic innervation assessed by MIBG in patients with failing and nonfailing hearts. J Nucl Cardiol. 1998;6:579–90.

36.

Kasama S, Toyama T, Kumakura H, Takayama Y, Ichikawa S, Suzuki T, et al. Effect of spironolactone on cardiac sympathetic nerve activity and left ventricular remodeling in patients with dilated cardiomyopathy. J Am Coll Cardiol. 2003;41:574–81.

37.

Cao JM, Fishbein MC, Han JB, et al. Relationship between regional cardiac hyperinnervation and ventricular arrhythmia. Circulation. 2000;101:1960–9.PubMedCrossRef

38.

Podrid PJ, Fuchs T, Candinas R. Role of the sympathetic nervous system in the genesis of ventricular arrhythmia. Circulation. 1990;82:103–13.

39.

McGhie AI, Corbett JR, Akers MS, et al. Regional cardiac adrenergic function using I-123 meta-iodobenzylguanidine tomographic imaging after acute myocardial infarction. Am J Cardiol. 1991;67:236–42.PubMedCrossRef

40.

Stanton MS, Tuli MM, Radtke NL, et al. Regional sympathetic denervation after myocardial infarction in humans detected noninvasively using I-123-metaiodobenzylguanidine. J Am Coll Cardiol. 1989;14:1519–26.PubMedCrossRef

41.

Mitrani RD, Klein LS, Miles WM, et al. Regional cardiac sympathetic denervation in patients with ventricular tachycardia in the absence of coronary artery disease. J Am Coll Cardiol. 1993;22:1344–53.PubMedCrossRef

42.

Arora R, Ferrick KJ, Nakata T, et al. I-123 MIBG imaging and heart rate variability analysis to predict the need for an implantable cardioverter defibrillator. J Nucl Cardiol. 2003;10:121–31.PubMedCrossRef

43.

Paul M, Schafers M, Kies P, et al. Impact of sympathetic innervation on recurrent life-threatening arrhythmias in the follow-up of patients with idiopathic ventricular fibrillation. Eur J Nucl Med Mol Imaging. 2006;33:866–70.PubMedCrossRef

44.

Akutsu Y, Kaneko K, Kodama Y, et al. The significance of cardiac sympathetic nervous system abnormality in the long-term prognosis of patients with a history of ventricular tachyarrhythmia. J Nucl Med. 2009;50:61–7.PubMedCrossRef

45.

Nishisato K, Hashimoto A, Nakata T, et al. Impaired cardiac sympathetic innervation and myocardial perfusion are related to lethal arrhythmia: quantification of cardiac tracers in patients with ICDs. J Nucl Med. 2010;51:1241–9.PubMedCrossRef

46.

Paul M, Wichter T, Kies P, et al. Cardiac sympathetic dysfunction in genotyped patients with arrhythmogenic right ventricular cardiomyopathy and risk of recurrent ventricular tachyarrhythmias. J Nucl Med. 2011;52:1559–65.PubMedCrossRef

47.

Terai H, Shimizu M, Ino H, et al. Cardiac sympathetic nerve activity in patients with hypertrophic cardiomyopathy with malignant ventricular tachyarrhythmias. J Nucl Cardiol. 2003;10:304–10.PubMedCrossRef

48.

Marshall A, Cheetham A, George RS, Mason M, Kelion AD. Cardiac iodine-123 metaiodobenzylguanidine imaging predicts ventricular arrhythmia in heart failure patients receiving an implantable cardioverter-defibrillator for primary prevention. Heart. 2012;98:1359–65.PubMedCrossRef

49.

Miranda CH, Figueiredo AB, Maciel BC, Marin-Neto JA, Simoes MV. Sustained ventricular tachycardia is associated with regional myocardial sympathetic denervation assessed with 123I-metaiodobenzylguanidine in chronic Chagas cardiomyopathy. J Nucl Med. 2011;52:504–10.PubMedCrossRef

50.

Bax JJ, Kraft O, Buxton AE, et al. 123 I-mIBG scintigraphy to predict inducibility of ventricular arrhythmias on cardiac electrophysiology testing: a prospective multicenter pilot study. Circ Cardiovasc Imaging. 2008;1:131–40.PubMedCrossRef

51.

Kasama S, Toyama T, Kaneko Y, et al. Relationship between late ventricular potentials and myocardial 123I-metaiodobenzylguanidine scintigraphy in patients with dilated cardiomyopathy with mild to moderate heart failure: results of a prospective study of sudden death events. Eur J Nucl Med Mol Imaging. 2012;39:1056–64.PubMedCrossRef

52.

Kioka H, Yamada T, Mine T, et al. Prediction of sudden death in patients with mild-to-moderate chronic heart failure by using cardiac iodine-123 metaiodobenzylguanidine imaging. Heart. 2007;93:1213–8.PubMedCrossRef

53.

Koutelou M, Katsikis A, Flevari P, et al. Predictive value of cardiac autonomic indexes and MIBG washout in ICD recipients with mild to moderate heart failure. Ann Nucl Med. 2009;23:677–84.PubMedCrossRef

54.

•• Boogers MJ, Borleffs CJ, Henneman MM, et al. Cardiac sympathetic denervation assessed with 123-iodine metaiodobenzylguanidine imaging predicts ventricular arrhythmias in implantable cardioverter-defibrillator patients. J Am Coll Cardiol. 2010;55:2769–77. This prospective trial enrolled 116 heart failure patients undergoing ICD implantation, and documented a markedly increased risk of ventricular arrhythmias requiring ICD therapy in those with a more severe pre-implant mIBG total defect score.PubMedCrossRef

55.

Wichter T, Matheja P, Eckardt L, et al. Cardiac autonomic dysfunction in Brugada syndrome. Circulation. 2002;105:702–6.PubMedCrossRef

56.

Kies P, Paul M, Gerss J, et al. Impaired cardiac sympathetic innervation in symptomatic patients with long QT syndrome. Eur J Nucl Med Mol Imaging. 2011;38:1899–907.PubMedCrossRef

57.

Daliento L, Folino AF, Menti L, Zanco P, Baratella MC, Dalla VS. Adrenergic nervous activity in patients after surgical correction of tetralogy of Fallot. J Am Coll Cardiol. 2001;38:2043–7.PubMedCrossRef

58.

• Dickfeld T, Lei P, Dilsizian V, et al. Integration of three-dimensional scar maps for ventricular tachycardia ablation with positron emission tomography-computed tomography. JACC Cardiovasc Imaging. 2008;1:73–82. This was the first published experience of integration of 3-dimensional mapping systems and demonstrated its clinical usefulness in ablation of ventricular tachycardia. PubMedCrossRef

59.

Tian J, Smith MF, Ahmad G, Dilsizian V, Jimenez A, Dickfeld T. Integration of 3-dimensional scar models from SPECT to guide ventricular tachycardia ablation. J Nucl Med. 2012;53:894–901.PubMedCrossRef

60.

Tian J, Jeudy J, Smith MF, et al. Three-dimensional contrast-enhanced multidetector CT for anatomic, dynamic, and perfusion characterization of abnormal myocardium to guide ventricular tachycardia ablations. Circ Arrhythmelectrophysiol. 2010;3:496–504.

61.

Tian J, Ahmad G, Mesubi O, Jeudy J, Dickfeld T. Three-dimensional delayed-enhanced cardiac MRI reconstructions to guide ventricular tachycardia ablations and assess ablation lesions. Circ Arrhythmelectrophysiol. 2012;5:e31–5.

62.

Marchlinski FE, Callans DJ, Gottlieb CD, Zado E. Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation. 2000;101:1288–96.PubMedCrossRef

63.

Shekhar R, Walimbe V, Raja S, et al. Automated 3-dimensional elastic registration of whole-body PET and CT from separate or combined scanners. J Nucl Med. 2005;46:1488–96.PubMed

64.

Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105:539–42.PubMedCrossRef

65.

Ahmad G, Mesubi O, Dickfeld T, et al. Assessment of Regional Cardiac Innervation Using I123-Meta-iodobenzylguanidine for Guiding Ventricular Tachycardia Ablation [abstract]. In: Scientific Sessions – Heart Rhythm Society 2012; May 9–12, 2012; Boston, MA.

66.

Klein T, Mesubi O, Ahmad G, et al. Assessment of Global Cardiac Innervation Using I123-Meta-iodobenzylguanidine Before and After Ventricular Tachycardia Ablation [abstract]. In: Scientific Sessions – American Heart Association 2012; November 4–6, 2012; Los Angeles, CA.

67.

Langer O, Halldin C. PET and SPET tracers for mapping the cardiac nervous system. Eur J Nucl Med Mol Imaging. 2002;29:416–34.PubMedCrossRef

68.

Bengel FM, Higuchi T, Javadi MS, Lautamaki R. Cardiac positron emission tomography. J Am Coll Cardiol. 2009;54:1–15.PubMedCrossRef

69.

Vesalainen RK, Pietila M, Tahvanainen KU, et al. Cardiac positron emission tomography imaging with [11C]hydroxyephedrine, a specific tracer for sympathetic nerve endings, and its functional correlates in congestive heart failure. Am J Cardiol. 1999;84:568–74.PubMedCrossRef

70.

Pietila M, Malminiemi K, Ukkonen H, et al. Reduced myocardial carbon-11 hydroxyephedrine retention is associated with poor prognosis in chronic heart failure. Eur J Nucl Med. 2001;28:373–6.PubMedCrossRef

71.

Sasano T, Abraham MR, Chang KC, et al. Abnormal sympathetic innervation of viable myocardium and the substrate of ventricular tachycardia after myocardial infarction. J Am Coll Cardiol. 2008;51:2266–75.PubMedCrossRef

72.

Fallavollita JA, Luisi Jr AJ, Michalek SM, et al. Prediction of arrhythmic events with positron emission tomography: PAREPET study design and methods. Contemp Clin Trials. 2006;27:374–88.PubMedCrossRef

Title: The Potential Role of Iodine-123 Metaiodobenzylguanidine Imaging for Identifying Sustained Ventricular Tachycardia in Patients with Cardiomyopathy
Authors: Thomas Klein
Vasken Dilsizian
Qi Cao
Wengen Chen
Timm-Michael Dickfeld
Publication date: 01-05-2013
Publisher: Current Science Inc.
Published in: Current Cardiology Reports / Issue 5/2013
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI: https://doi.org/10.1007/s11886-013-0359-1

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The Potential Role of Iodine-123 Metaiodobenzylguanidine Imaging for Identifying Sustained Ventricular Tachycardia in Patients with Cardiomyopathy

Abstract

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Abstract

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