title: Myocardial123I-mIBG scintigraphy in relation to markers of inflammation and long-term clinical outcome in patients with stable chronic heart failure.
abstract: Chronic 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 (123I-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) of123I-mIBG parameters and these inflammatory markers was evaluated.
  
  
  
  Fifty-five CHF patients (age 66.3 ± 8.0 years, 78% male, LVEF 22.4 ± 6.3) referred for cardiac123I-mIBG imaging were included. At 15 minutes (early) and 4 hours (late) after i.v. administration of123I-mIBG (185 MBq), planar images were acquired. Early Heart/Mediastinum (H/M) ratio, late H/M ratio, and123I-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 (s)E-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 before123I-mIBG administration.
  
  
  
  Mean early H/M ratio was 2.12 ± 0.39, late H/M ratio was 1.84 ± 0.40, and123I-mIBG WO was 13.0 ± 10.9. LVEF was the only independent predictor of late H/M ratio (adjusted R2= 0.100, p = 0.011). NT-proBNP was an independent predictor of123I-mIBG WO (adjusted R2= 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 and123I-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.
  
  
  
  Inflammation 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.
authors.affiliation: Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands. d.o.verschure@amc.uva.nl.|Department of Cardiology, Zaans Medical Center, Zaandam, The Netherlands. d.o.verschure@amc.uva.nl.
authors.forename: Derk O
authors.initials: DO
authors.lastname: Verschure
authors.affiliation: Departments of Respiratory Medicine and Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: René
authors.initials: R
authors.lastname: Lutter
authors.affiliation: Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
authors.forename: Berthe L F
authors.initials: BLF
authors.lastname: van Eck-Smit
authors.affiliation: Cardiology Centers of the Netherlands, Amsterdam, The Netherlands.
authors.forename: G Aernout
authors.initials: GA
authors.lastname: Somsen
authors.affiliation: Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Verberne
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D007249:Inflammation; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013318:Stroke Volume
chemical_list: D015415:Biomarkers; D007457:Iodine Radioisotopes; D010446:Peptide Fragments; D019275:Radiopharmaceuticals; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D019797:3-Iodobenzylguanidine; C000614958:Iodine-123
keywords: Heart failure; cardiac sympathetic activity; inflammation; planar 123I-mIBG myocardial scintigraphy; prognosis