Myocardial 123I-mIBG scintigraphy in relation to markers of inflammation and long-term clinical outcome in patients with stable chronic heart failureReport as inadecuate




Myocardial 123I-mIBG scintigraphy in relation to markers of inflammation and long-term clinical outcome in patients with stable chronic heart failure - Download this document for free, or read online. Document in PDF available to download.

Journal of Nuclear Cardiology

pp 1–9

First Online: 17 November 2016Received: 20 June 2016Accepted: 14 September 2016

Abstract

AimChronic heart failure CHF results in both increased cardiac sympathetic activity and myocardial inflammation. The aim of this study was to identify the relationship between severity of heart failure i.e., NT-proBNP and LVEF, cardiac sympathetic activity I-mIBG scintigraphy, and measures of inflammation in subjects with stable, optimally treated CHF. In addition, the predictive value for cardiac events i.e., ventricular arrhythmia, progression of CHF and cardiac death of I-mIBG parameters and these inflammatory markers was evaluated.

Materials and MethodsFifty-five CHF patients age 66.3 ± 8.0 years, 78% male, LVEF 22.4 ± 6.3 referred for cardiac I-mIBG imaging were included. At 15 minutes early and 4 hours late after i.v. administration of I-mIBG 185 MBq, planar images were acquired. Early Heart-Mediastinum H-M ratio, late H-M ratio, and I-mIBG washout WO were calculated. NT-proBNP and markers of inflammation i.e., C-reactive protein CRP, IL-1β, IL-6, IL-8, IL-10, IL-12p40, tumor necrosis factor-α TNF-α, soluble sE-selectin, myeloperoxidase MPO, plasminogen activator inhibitor-1 PAI-1, tPA, tumor necrosis factor receptor TNFR 1 and 2, and interferon IFN α and β were measured in blood plasma samples, taken just before I-mIBG administration.

ResultsMean early H-M ratio was 2.12 ± 0.39, late H-M ratio was 1.84 ± 0.40, and I-mIBG WO was 13.0 ± 10.9. LVEF was the only independent predictor of late H-M ratio adjusted R = 0.100, p = 0.011. NT-proBNP was an independent predictor of I-mIBG WO adjusted R = 0.090, p = 0.015. CRP, IL12p40, TNF-α, sE-selectin, MPO, PAI-1, tPA, and TNFR2 were not related to late H-M ratio and I-mIBG WO. During a median follow-up of 34 months 2–58 months, 13 patients experienced a cardiac event ventricular arrhythmia 4, progression of CHF 4, and cardiac death 5. Univariate Cox regression analysis showed that the risk of a cardiac event was associated with CRP HR 1.047 1.013–1.081, NT-proBNP HR 1.141 1.011–1.288, MPO HR 0.998 0.996–1.000, and late H-M ratio HR 0.182 0.035–0.946. Multivariate Cox regression analysis showed that only CRP, NT-proBNP, MPO, and IL-12p40 were predictors of a cardiac event.

ConclusionInflammation and cardiac sympathetic activity seem not to be related in stable CHF patients. This is corroborated by the finding that they both provide prognostic information in this specific CHF population. The current findings should be regarded as insightful but preliminary.

KeywordsHeart failure cardiac sympathetic activity planar I-mIBG myocardial scintigraphy inflammation prognosis AbbreviationsCHFChronic heart failure

mIBGMeta-iodobenzylguanidine

H-M ratioHeart-to-mediastinum ratio

WOWashout

LVEFLeft ventricle ejection fraction

NT-proBNPN-terminal pro B-type Natriuretic Peptide

NYHANew York Heart Association

CECardiac event

CRPC-reactive protein

MPOMyeloperoxidase

TNF-αTumor necrosis factor-α

ILInterleukin

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Electronic supplementary materialThe online version of this article doi:10.1007-s12350-016-0697-7 contains supplementary material, which is available to authorized users.

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Author: Derk O. Verschure - René Lutter - Berthe L. F. van Eck-Smit - G. Aernout Somsen - Hein J. Verberne

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