title: Assessment of123I-mIBG and99mTc-tetrofosmin single-photon emission computed tomographic images for the prediction of arrhythmic events in patients with ischemic heart failure: Intermediate severity innervation defects are associated with higher arrhythmic risk.
abstract: 123I-mIBG planar image heart-to-mediastinum ratios effectively risk-stratify heart failure (HF) patients. The value of single-photon emission computed tomographic (SPECT) imaging for identifying increased risk of ventricular arrhythmias is less clear. This study sought to determine if findings from simultaneous interpretation of123I-mIBG and99mTc-tetrofosmin SPECT are predictive of arrhythmic events (ArEs).
  
  
  
  123I-mIBG SPECT images from 622 patients with ischemic HF were presented in standard displays alongside99mTc-tetrofosmin images. Consensus interpretations using a 17-segment model produced summed scores. Cox proportional hazards analyses related findings to adjudicated ArEs over 2 years.
  
  
  
  471 patients had images adequate for total 17-segment scoring. There were 48 ArEs (10.2%). Neither123I-mIBG nor99mTc-tetrofosmin SPECT summed scores were univariate predictors. On multivariate proportional hazards analysis, the123I-mIBG SPECT score was independently predictive of ArEs (HR: 0.975, 95% CI 0.951-0.999, P = 0.042), but HR<1 indicated that risk decreased with increasing score. This occurred because patients with intermediately abnormal SPECT studies had a higher likelihood of ArEs compared to patients with extensive abnormalities.
  
  
  
  The presumption of a monotonic increase in ArE risk with increasing summed123I-mIBG SPECT score may not be correct as ischemic HF patients with abnormalities of intermediate extent appear at highest risk.
authors.affiliation: Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East-210th Street, Bronx, NY, 10467-2490, USA. mtravin@attglobal.net.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Travin
authors.affiliation: Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Milena J
authors.initials: MJ
authors.lastname: Henzlova
authors.affiliation: Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Berthe L F
authors.initials: BLF
authors.lastname: van Eck-Smit
authors.affiliation: Division of Cardiology, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY, USA.
authors.forename: Diwakar
authors.initials: D
authors.lastname: Jain
authors.affiliation: Department of Nuclear Medicine, Hospital Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Carrió
authors.affiliation: Department of Radiology, Emory University Hospital, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Russell D
authors.initials: RD
authors.lastname: Folks
authors.affiliation: Department of Radiology, Emory University Hospital, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Ernest V
authors.initials: EV
authors.lastname: Garcia
authors.affiliation: Diagram Consulting, Kihei, HI, USA.|Formerly Employed by GE Healthcare, Kihei, HI, USA.
authors.forename: Arnold F
authors.initials: AF
authors.lastname: Jacobson
authors.affiliation: Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Verberne
mesh_terms: D019797:3-Iodobenzylguanidine; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging* / Q000401:mortality*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D038622:Internationality; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000401:mortality; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods* / Q000706:statistics & numerical data; D015996:Survival Rate
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; C078700:technetium tc-99m tetrofosmin
keywords: 123I-mIBG; SPECT; arrhythmias; heart failure