Key result
Late heart-to-mediastinum ratio on 123I-mIBG scintigraphy independently predicted CRT response, specifically LVEF improvement to >35% (P=0.0014).
Why the study?
One-third of chronic heart failure patients do not benefit from CRT selected by current guideline parameters, prompting evaluation of whether 123I-mIBG-assessed cardiac sympathetic activity could optimize CRT patient selection.
Does 123I-mIBG scintigraphy predict functional response 1 year after CRT implantation in patients with chronic heart failure?
Observational (n=78)
Does 123I-mIBG scintigraphy predict functional response 1 year after CRT implantation in patients with chronic heart failure?
Cardiac 123I-mIBG scintigraphy assessing early and late H/M ratio can independently predict LVEF improvement following CRT implantation, potentially optimizing patient selection.
Answers are grounded in this paper and cite their sources.
Late H/M ratio may aid CRT response prediction in HF; hypothesis-generating pending prospective validation.
AIMS: Cardiac resynchronization therapy (CRT) is a disease-modifying therapy in patients with chronic heart failure (CHF). Current guidelines ascribe CRT eligibility on three parameters only: left ventricular ejection fraction (LVEF), QRS duration, and New York Heart Association (NYHA) functional class. However, one-third of CHF patients does not benefit from CRT. This study evaluated whether 123I-meta-iodobenzylguanidine (123I-mIBG) assessed cardiac sympathetic activity could optimize CRT patient selection. METHODS AND RESULTS: A total of 78 stable CHF subjects (age 66.8 ± 9.6 years, 73% male, LVEF 25.2 ± 6.7%, QRS duration 153 ± 23 ms, NYHA 2.2 ± 0.7) referred for CRT implantation were enrolled. Subjects underwent 123I-mIBG scintigraphy prior to implantation. Early and late heart-to-mediastinum (H/M) ratio and 123I-mIBG washout were calculated. CRT response was defined as either an increase of LVEF to >35%, any improvement in LVEF of >10%, QRS shortening to <150 ms, or improvement in NYHA class of >1 class. In 33 patients LVEF increased to >35%, QRS decreased <150 ms in 36 patients, and NYHA class decreased in 33 patients. Late H/M ratio and hypertension were independent predictors of LVEF improvement to >35% (P = 0.0014 and P = 0.0149, respectively). In addition, early H/M ratio, LVEF, and absence of diabetes mellitus (DM) were independent predictors for LVEF improvement by >10%. No independent predictors were found for QRS shortening to <150 ms or improvement in NYHA class. CONCLUSION: Early and late H/M ratio were independent predictors of CRT response when improvement of LVEF was used as measure of response. Therefore, cardiac 123I-mIBG scintigraphy may be used as a tool to optimize selection of subjects that might benefit from CRT.
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Verschure et al. (2020) conducted an observational in Chronic heart failure (CHF) (n=78). 123I-mIBG scintigraphy (early and late heart-to-mediastinum ratio) was evaluated on CRT response (increase of LVEF to >35%, improvement in LVEF >10%, QRS shortening <150 ms, or NYHA class improvement >1 class) (p=0.0014). Late heart-to-mediastinum ratio on 123I-mIBG scintigraphy independently predicted CRT response, specifically LVEF improvement to >35% (P=0.0014).
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