Cardiac innervation imaging as a risk stratification tool for potential device therapy candidates

Abstract

As a scintigraphic approach evaluating cardiac nerve integrity, 123 I-metaiodobenzylguanidine (123 I-mIBG) has been recently Food and Drug Administration approved. A great deal of progress has been made by the prospective ADMIRE-HF trial, which primarily demonstrated the association of denervated myocardium assessed by 123 I-mIBG and cardiac events. However, apart from risk stratification, myocardial nerve function evaluated by molecular imaging should also be expanded to other clinical contexts, in particular to guide the referring cardiologist in selecting appropriate candidates for specific therapeutic interventions. In the present issue of the Journal of Nuclear Cardiology Ò , the use of 123 I-mIBG for identifying cardiomyopathy patients, which would most likely not benefit from ICD due to low risk of arrhythmias, is described. If we aim to deliver on the promise of cardiac innervation imaging as a powerful tool for risk stratification in a manner similar to nuclear oncology, studies such as the one reviewed here may imply an important step to lay the proper groundwork for a more widespread adoption in clinical practice.

The prognostic value of 123I-mIBG SPECT cardiac imaging in heart failure patients: a systematic review

“…Iodine123-Metaiodobenzylguanidine ( 123 I-mIBG), an analog of norepinephrine, is a useful tool for detecting abnormalities in the myocardial adrenergic nervous system in HF patients and can be successfully used to assess their prognosis. 2 – 4 123 I-mIBG represents a tracer of sympathetic neuron integrity and function and the most widely used imaging agent for studying the causes and effects of cardiac sympathetic hyperactivity. 5 Semi-quantitative myocardial 123 I-mIBG parameters have proved to be of prognostic value in HF.…”

Application of 123I-MIBG myocardial maximum standardized uptake value to characterize cardiac function in patients with pheochromocytoma: comparison with echocardiography

“…Several reports stated that semiquantitative analysis of [ 123 I]-MIBG cardiac planar or single-photon emission computed tomography (SPECT) can predict the prognoses of patients with chronic heart failure [3][4][5][6]. However, estimating the uptake of local tracer using SPECT images can be technically complex, and inter-or intraobserver variability might not be negligible [6].…”