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Holly, T.A., Abbott, B.G., Al-Mallah, M., Calnon, D.A., Cohen, M.C., DiFilippo, F.P., Ficaro, E.P., Freeman, M.R., Hendel, R.C., Jain, D., Leonard, S.M., Nichols, K.J., Polk, D.M. and Soman, P. (2010) ASNC Imaging Guidelines for Nuclear Cardiology Procedures. Journal of Nuclear Cardiology, 17, 941-973.

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• TITLE: Is There an Incremental Prognostic Value of Evaluating Left Ventricular Dyssynchrony by Gated SPECT in Patients with Systolic Heart Failure and Altered Myocardial Sympathetic Innervation as Evaluated by Cardiac I-123 mIBG Imaging?

  AUTHORS: Akif Mohammed, Gordon Jacobsen, Karthik Ananthasubramaniam

  KEYWORDS: SPECT Dyssynchrony, I-123 mIBG, Myocardial Sympathetic Innervation, Heart to Mediastinum Ratio

  JOURNAL NAME: World Journal of Nuclear Science and Technology, Vol.6 No.3, July 20, 2016

  ABSTRACT: Background: Altered myocardial sympathetic innervation activity (AMSI) is known to be present in systolic heart failure patients (SHF) and recently SPECT imaging using I-123 mIBG heart to mediastinum (H/M) ratio and LVMD collectively affect clinical outcomes and other cardiovascular parameters. Objectives: The objectives are to examine the clinical characteristics and incremental prognostic value for MACE of LVMD determined by SPECT in SHF patients with or without abnormal cardiac MIBG uptake (H/M ratio tion both of which assess the extent of dispersion of LV activation during contraction as a marker of LVMD. Patients were followed up for a mean period of 6 years. The primary end point was mortality from any cause and secondary end point was heart failure admission or myocardial infarction or ICD shock. Results: 2 Groups were defined: Group A: n = 17 with H/M MIBG ratio −LVMD. Baseline characteristics, cardiac risk factors and medications were comparable between both groups. LVEF was lower and RBBB was less common in Group A. There was no statistical difference in achievement of primary or secondary end points in the two groups including death heart failure readmissions, ICD shocks or MI. Conclusions: In our pilot study, we did not find definitive value of adding SPECT based LVMD to abnormal cardiac MIBG imaging in SHF patients with regards to predicting outcomes. Although our sample size is too small to make any definitive conclusions, it is possible that LVMD works independently through different pathways in the progression of SHF and hence may not necessarily add incremental value to AMSI determination using MIBG.