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Annals of Nuclear Medicine
Published in: Annals of Nuclear Medicine 7/2009

01-09-2009 | Original Article

Predictive value of cardiac autonomic indexes and MIBG washout in ICD recipients with mild to moderate heart failure

Authors: Maria Koutelou, Athanasios Katsikis, Peny Flevari, George Theodorakis, Efthimios Livanis, Michalis Georgiadis, Vasilios Voudris, Dimitrios Kremastinos

Published in: Annals of Nuclear Medicine | Issue 7/2009

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Abstract

Objective

We aimed at evaluating the combined use of heart rate variability (HRV), baroreflex sensitivity (BRS), and MIBG imaging in the risk stratification for sudden cardiac death (SCD) of patients with mild to moderate heart failure.

Methods

Twenty-five patients (17 male and 8 female, mean age 63 ± 5 years, mean LVEF 36 ± 3%) with a recently implanted defibrillator (ICD) and mild (NYHA I-II) heart failure due to either ischemic (n = 15) or dilated (n = 10) cardiomyopathy were studied. One week after ICD implantation they underwent (a) baroreflex sensitivity (BRS) evaluation to bolus phenylephrine by the Oxford method, (b) 24-h heart rate variability (HRV) assessment, and (c) MIBG imaging. The mean patient follow-up was 32 ± 10 months. Simple correlation and stepwise multiple regression analysis was performed to evaluate (a) if the number of sustained ventricular tachycardia (cycle length <330 ms) or fibrillation episodes per month is related to one or more of MIBG, BRS, and HRV indexes and (b) if MIBG % washout is related to HRV and/or BRS.

Results

The frequency of fast ventricular arrhythmic episodes (FVAE) demonstrated an inverse relation to BRS (p < 0.0001), rMSSD (p = 0.001), and pNN50 (p = 0.0034), while it was positively related to LF (p < 0.0001) and MIBG % washout (p = 0.001). BRS, LF, rMSSD, and MIBG washout were also independent predictors of FVAE. MIBG washout was related to only one HRV marker (SDNN-I, p < 0.0001), while no correlation was observed with BRS.

Conclusions

In ICD recipients with well-compensated heart failure, autonomic markers derived from BRS, HRV, and MIBG studies are related to FVAE. These markers have limited inter-dependency and constitute useful means for SCD risk stratification in this subgroup of patients.
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Metadata
Title
Predictive value of cardiac autonomic indexes and MIBG washout in ICD recipients with mild to moderate heart failure
Authors
Maria Koutelou
Athanasios Katsikis
Peny Flevari
George Theodorakis
Efthimios Livanis
Michalis Georgiadis
Vasilios Voudris
Dimitrios Kremastinos
Publication date
01-09-2009
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 7/2009
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-009-0289-6

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