title: Cardiac sympathetic innervation assessed with (123)I-MIBG retains prognostic utility in diabetic patients with severe left ventricular dysfunction evaluated for primary prevention implantable cardioverter-defibrillator.
abstract: BACKGROUND
  Scintigraphy with iodine-123-metaiodobenzylguanidine ((123)I-MIBG) is a non-invasive tool for the assessment of cardiac sympathetic innervation (CSI) that has proven to be an independent predictor of survival. Recent studies have shown that diabetic patients with heart failure (HF) have a higher deterioration in CSI. It is unknown if (123)I-MIBG has the same predictive value for diabetic and non-diabetic patients with advanced HF. An analysis is performed to determine whether CSI with (123)I-MIBG retains prognostic utility in diabetic patients with HF, evaluated for a primary prevention implantable cardioverter-defibrillator (ICD).
  
  
  METHODS
  Seventy-eight consecutive HF patients (48 diabetic) evaluated for primary prevention ICD implantation were prospectively enrolled and underwent (123)I-MIBG to assess CSI (heart-to-mediastinum ratio - HMR). A Cox proportional hazards multivariate analysis was used to determine the influence of (123)I-MIBG images for prediction of cardiac events in both diabetic and non-diabetic patients. The primary end-point was a composite of arrhythmic event, cardiac death, or admission due to HF.
  
  
  RESULTS
  During a mean follow-up of 19.5 [9.3-29.3] months, the primary end-point occurred in 24 (31%) patients. Late HMR was significantly lower in diabetic patients (1.30 vs. 1.41, p=0.014). Late HMR≤1.30 was an independent predictor of cardiac events in diabetic (hazard ratio 4.53; p=0.012) and non-diabetic patients (hazard ratio 12.31; p=0.023).
  
  
  CONCLUSIONS
  Diabetic patients with HF evaluated for primary prevention ICD show a higher deterioration in CSI than non-diabetics; nevertheless (123)I-MIBG imaging retained prognostic utility for both diabetic and non-diabetic patients.
authors.affiliation: Cardiac Imaging Unit, ERESA, Consorcio Hospital General Universitario de Valencia, Valencia, Spain. Electronic address: mpgarcia@eresa.com.
authors.forename: P
authors.initials: P
authors.lastname: García-González
authors.affiliation: Department of Cardiology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: Ó
authors.initials: Ó
authors.lastname: Fabregat-Andrés
authors.affiliation: Department of Nuclear Medicine ERESA, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Cozar-Santiago
authors.affiliation: Department of Nuclear Medicine ERESA, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Sánchez-Jurado
authors.affiliation: Cardiac Imaging Unit, ERESA, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Estornell-Erill
authors.affiliation: Department of Cardiology, Hospital Marina Salud, Denia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Valle-Muñoz
authors.affiliation: Department of Cardiology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Quesada-Dorador
authors.affiliation: Department of Cardiology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain; Department of Medicine, Universitat de Valencia, Valencia, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Payá-Serrano
authors.affiliation: Department of Nuclear Medicine ERESA, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Ferrer-Rebolleda
authors.affiliation: Department of Cardiology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain; Department of Medicine, Universitat de Valencia, Valencia, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Ridocci-Soriano
mesh_terms: D019797:3-Iodobenzylguanidine; D017147:Defibrillators, Implantable; D003920:Diabetes Mellitus; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*; D006321:Heart / Q000294:innervation*; D006801:Humans; D015999:Multivariate Analysis; D011322:Primary Prevention; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D013564:Sympathetic Nervous System / Q000000981:diagnostic imaging*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine
keywords: Diabetes mellitus; Heart failure; Insuficiencia cardiaca; MIBG; Prognosis; Pronóstico; Sistema nervioso simpático; Sympathetic nervous system