Cardiac Sympathetic Imaging With mIBG in Heart Failure
Ignasi Carrió, MD*,*,
Martin R. Cowie, MD, MSc ,
Junichi Yamazaki, MD ,
James Udelson, MD||,
Paolo G. Camici, MD*,
* Hospital Sant Pau, Barcelona, Spain
National Heart & Lung Institute, Imperial College, London, United Kingdom
Clinical Sciences Centre, Imperial College, London, United Kingdom
Toho University School of Medicine, Tokyo, Japan
|| Tufts University School of Medicine, Boston, Massachusetts
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Figure 1 Quantification of Cardiac mIBG Activity
(A) Calculation of meta-iodobenzylguanidine (mIBG) heart-to-mediastinum ratio (HMR) and wash-out rate on an anterior view of the thorax. Regions of interest (ROI) are drawn over the heart and mediastinum. (B) Normal cardiac mIBG activity in a patient with HMR: 1.80. (C) Severely decreased cardiac mIBG activity in a patient with HMR: 1.10.
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Figure 2 Polar Map Display of the Regional mIBG Distribution From a SPECT Study
The extent map displays in black the pixels with counts –2 standard deviations or less compared with the normal file. The severity map displays the defect severity, after dividing the total count difference between the black pixels and the normal region by the total number of pixels. The wash-out rate can be estimated for each segment as well as for the whole ventricle. Ant = anterior; Inf = inferior; Lat = lateral; mIBG = meta-iodobenzylguanidine; Sep = septal; SPECT = single-photon emission computed tomography.
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Figure 3 Examples of Low- and High-Risk Patients
(A)
mIBG images of a typical low-risk patient, with HMR: 1.70. Notice the normal cardiac mIBG activity on the late planar view and the normal regional distribution on the tomographic images. (B)
mIBG images of a typical high-risk patient, with HMR: 1.10. Notice the very poor cardiac activity on the planar and tomographic images. Abbreviations as in Figure 1.
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Figure 4 Retrospective European Study
(A) HMR and 2-year major cardiac events (MCE). (B) Receiver-operator characteristic analysis: a threshold value of heart to mediastinum (H/M) ratio 1.75 yielded a sensitivity of 84% and a specificity of 60% to predict events. Reprinted, with permission, from Agostini et al. (39). NYHA = New York Heart Association.
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