Cardiac 123 I- m IBG scintigraphy is associated with freedom of appropriate ICD therapy in stable chronic heart failure patients

Le résumé fourni par la source

Aim Chronic heart failure (CHF) is a life-threatening clinical syndrome, partly due to sudden cardiac death (SCD). Implantable cardioverter defibrillators (ICD) for primary prevention of SCD have improved overall survival of CHF patients. However, a high percentage of patients never receives appropriate ICD therapy. This prospective multicentre study evaluated whether cardiac sympathetic activity assessed by 123 I- m IBG scintigraphy could be helpful in selecting patients for ICD implantation. Materials and methods 135 stable CHF subjects (age 64.5±9.3years, 79% male, LVEF 25±6%) referred for prophylactic ICD implantation were enrolled in 13 institutions. All subjects underwent planar and SPECT 123 I- m IBG scintigraphy. Early and late heart-to-mediastinum (H/M) ratio, 123 I- m IBG washout (WO) and late summed scores were calculated. The primary endpoint was appropriate ICD therapy. The secondary endpoint was defined as the combined endpoint of all first cardiac events: appropriate ICD therapy, progression of heart failure (HF) and cardiac death. Results During a median follow-up of 30months (6–68months), 24 subjects (17.8%) experienced a first cardiac event (appropriate ICD therapy [12], HF progression [6], cardiac death [6]). Late H/M ratio and defect size of 123 I- m IBG SPECT were not associated with appropriate ICD therapy. However, late H/M ratio was independently associated with the combined endpoint (HR 0.135 [0.035–0.517], p =0.001). Post-hoc analysis showed that the combination of late H/M ratio (HR 0.461 [0.281–0.757]) and LVEF (HR 1.052 [1.021–1.084]) was significantly associated with freedom of appropriate ICD therapy ( p <0.001). Conclusion 123 I- m IBG scintigraphy seems to be helpful in selecting CHF subjects who might not benefit from ICD implantation.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.