Key result
Post-TAVR delayed heart-mediastinum ratio on MIBG imaging linked to ~33% higher MACE risk.
Why the study?
In patients with aortic valve stenosis, the prognostic impact of cardiac sympathetic nervous function and its improvement after TAVR remained unclear.
Does cardiac 123I-metaiodobenzylguanidine (MIBG) imaging predict major adverse cardiac events in patients after transcatheter aortic valve replacement?
Observational (n=111)
No
Does cardiac 123I-metaiodobenzylguanidine (MIBG) imaging predict major adverse cardiac events in patients after transcatheter aortic valve replacement?
Cardiac 123I-MIBG imaging before and after TAVR provides prognostic value, with improvement or high post-TAVR delayed heart-mediastinum ratio predicting a lower incidence of major adverse cardiac events.
Answers are grounded in this paper and cite their sources.
May refine post-TAVR risk stratification; leaves open whether MIBG imaging alters management or outcomes.
Background In patients with aortic valve stenosis (AS), cardiac sympathetic nervous (CSN) dysfunction and its improvement after TAVR have been reported; however, the prognostic impact of CSN function remains unclear. This study investigated the prognostic value of cardiac 123I-metaiodobenzylguanidine (MIBG) imaging for the prediction of cardiac events after transcatheter aortic valve replacement (TAVR). Methods This study was a single-center prospective observational study that enrolled patients with AS or failed surgical bioprostheses between July 2017 and May 2019. MIBG scintigraphy was performed before and after TAVR to evaluate the delayed heart–mediastinum ratio (d-H/M). Patients were classified into three pairs of groups based on the baseline and post-TAVR d-H/M (≥2.0 or <2.0) and on the presence of TAVR-related improvement of d-H/M. The study endpoints were major adverse cardiac events (MACE), including all-cause death, myocardial infarction, and hospitalization due to heart failure. The association of d-H/M with MACE following TAVR was based on a Cox proportional hazards ratio model adjusted for multiple prognostic variables. Results Of 187 consecutive patients who underwent TAVR, 111 (31 men; median age: 86 years) were evaluated. Over a median follow-up of 366 days, 16 (14.4%) patients had MACE. The incidence of MACE was significantly lower in patients with d-H/M improvement and/or the high post-TAVR d-H/M (≥2.0). Post-TAVR d-H/M had significant impacts on MACE, with an adjusted hazard ratio of 1.326 (95% confidence interval, 0.139–2.515; p=0.027). Conclusions Both d-H/M improvement and high post-TAVR d-H/M were associated with better prognosis in patients who underwent TAVR. Cardiac MIBG imaging was useful for predicting cardiac events after TAVR.
No takes yet. Share an insight, caveat, or question.
Kadoya et al. (2020) conducted an observational in Aortic valve stenosis or failed surgical bioprostheses (n=111). Post-TAVR delayed heart-mediastinum ratio (d-H/M) on cardiac 123I-MIBG imaging vs. Low post-TAVR d-H/M (<2.0) or no improvement was evaluated on Major adverse cardiac events (MACE), including all-cause death, myocardial infarction, and hospitalization due to heart failure (HR 1.326, 95% CI 0.139-2.515, p=0.027). Post-TAVR delayed heart-mediastinum ratio on cardiac MIBG imaging was significantly associated with major adverse cardiac events (adjusted HR 1.326; 95% CI 0.139-2.515; p=0.027).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: