Anda di halaman 1dari 9

Eur J Nucl Med Mol Imaging (2012) 39:10561064 DOI 10.

1007/s00259-012-2092-1

ORIGINAL ARTICLE

Relationship between late ventricular potentials and myocardial 123I-metaiodobenzylguanidine scintigraphy in patients with dilated cardiomyopathy with mild to moderate heart failure: results of a prospective study of sudden death events
Shu Kasama & Takuji Toyama & Yoshiaki Kaneko & Toshiya Iwasaki & Hiroyuki Sumino & Hisao Kumakura & Kazutomo Minami & Shuichi Ichikawa & Naoya Matsumoto & Yuichi Sato & Masahiko Kurabayashi

Received: 29 November 2011 / Accepted: 15 February 2012 / Published online: 14 March 2012 # Springer-Verlag 2012

Abstract Purpose Late ventricular potentials (LPs) are considered to be useful for identifying patients with heart failure at risk of developing ventricular arrhythmias. 123I-metaiodobenzylguanidine (MIBG) scintigraphy, which is used to evaluate cardiac sympathetic activity, has demonstrated cardiac sympathetic denervation in patients with malignant ventricular tachyarrhythmias. This study was undertaken to clarify the relationship between LPs and 123I-MIBG scintigraphy findings in patients with dilated cardiomyopathy (DCM).
S. Kasama (*) : T. Toyama : Y. Kaneko : M. Kurabayashi Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma 371-0034, Japan e-mail: s-kasama@bay.wind.ne.jp S. Kasama : T. Iwasaki : H. Sumino : H. Kumakura : K. Minami : S. Ichikawa Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Gunma, Japan N. Matsumoto Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan Y. Sato Department of Imaging, Health Park Clinic, Takasaki, Gunma, Japan

Methods A total of 56 patients with DCM were divided into an LP-positive group (n024) and an LP-negative group (n0 32). During the compensated period, the delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined from 123IMIBG images and plasma brain natriuretic peptide (BNP) concentrations were measured. Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF) were simultaneously determined by echocardiography. Results LVEDV, LVESV, LVEF and plasma BNP concentrations were similar in the two groups. However, TDS was significantly higher (358 vs. 286, p<0.005), the H/M ratio was significantly lower (1.570.23 vs. 1.780.20, p< 0.005), and the WR was significantly higher (6014% vs. 46 12%, p < 0.001) in the LP-positive than in the LPnegative group. The average follow-up time was 4.5 years, and there were nine sudden deaths among the 56 patients (16.1%). In logistic regression analysis, the incidences of sudden death events were similar in those LP-negative with WR <50%, LP-negative with WR 50% and LP-positive with WR <50% (0%, 10.0% and 14.3%, respectively), but was significantly higher (41.2%) in those LP-positive with WR 50% (p<0.01, p<0.05, and p<0.05, respectively). Conclusion The present study demonstrated that the values of cardiac 123I-MIBG scintigraphic parameters were worse in LP-positive DCM patients than in LP-negative DCM patients. Furthermore, in LP-positive DCM patients with a

Eur J Nucl Med Mol Imaging (2012) 39:10561064

1057

high WR, the incidence of sudden death events was higher than that in other subgroups of DCM patients. Keywords 123I-MIBG . Late ventricular potentials . Dilated cardiomyopathy

Introduction Patients with idiopathic dilated cardiomyopathy (DCM) have a high incidence of ventricular arrhythmias [1] and are at increased risk of sudden death from ventricular tachycardia (VT) and ventricular fibrillation [2]. The histopathological and electrophysiological characteristics of ventricular arrhythmias in idiopathic DCM are even less well defined than those of coronary artery disease. A variety of factors may contribute to the genesis of ventricular tachyarrhythmias in DCM patients. Therefore, identification of patients with idiopathic DCM at risk of malignant ventricular arrhythmias is very important for optimal medical management. Late ventricular potentials (LPs) detected by signalaveraged electrocardiography (ECG) in patients with VT are caused by delayed and fragmented ventricular activation. These LPs are used to identify patients at risk of lifethreatening arrhythmias, and indicate an increased risk of malignant ventricular arrhythmias and sudden death in those with ischaemic heart disease and congestive heart failure [3, 4]. Myocardial imaging with 123I-metaiodobenzylguanidine (MIBG), an analogue of norepinephrine, is useful for detecting abnormalities of the myocardial adrenergic nervous system in DCM patients [57]. Cardiac sympathetic nerve activity evaluated by 123I-MIBG scintigraphy has prognostic value in these patients [7, 8]. Moreover, recent clinical studies have suggested that 123I-MIBG imaging predicts ventricular arrhythmias in patients with heart failure [9, 10]. In the present study, we clarified the relationship between LPs and the findings of 123I-MIBG scintigraphy in patients with mild to moderate heart failure (i.e. patients at low risk of sudden death events) due to DCM, and determined whether the presence of LPs and the findings of 123I-MIBG scintigraphy are a reliable sudden death marker in these patients.

examination was performed in each patient prior to enrolment in the study. The patients were in New York Heart Association (NYHA) functional class II or III at the time of enrolment. Coronary angiography revealed normal coronary arteries in all patients. Acute or chronic myocarditis was excluded by examination of left ventricular endomyocardial biopsy specimens. None of the patients had a history of alcohol abuse. Standard therapy for heart failure was started in all the patients soon after admission. After heart failure had been controlled, all subjects were treated with an angiotensinconverting enzyme inhibitor and/or and angiotensin receptor blocker, and also treated with diuretics. None of the patients received a beta-blocker or antiarrhythmic agents until 123IMIBG scintigraphy had been performed, because these treatments might have affected cardiac sympathetic nerve activity [8, 11, 12]. During the stable period, a signalaveraged ECG, 24-hour Holter monitor, echocardiography and 123I-MIBG scintigraphy were performed, and the plasma concentration of brain natriuretic peptide (BNP) was also determined in all patients. After 123I-MIBG scintigraphy, almost all patients received oral beta-blockers, and if required, oral antiarrhythmic agents were added and continued. Exclusion criteria included the existence of sustained VT or ventricular fibrillation during hospitalization, because the purpose of this study was evaluation of low-risk patients for sudden death events. Patients with diabetes or glucose intolerance were also excluded. In addition, patients with diseases affecting the autonomic nerve system, those with hepatic or renal dysfunction, and those who had received reserpine or tranquilizers that could have affected the automatic nerve system, were excluded. The design was a prospective observational study and was approved by the ethics review board of our institution, and written informed consent was obtained from all participants. Signal-averaged ECG Body surface ECG recordings were obtained during sinus rhythm from bipolar X, Y, and Z leads with a signalaveraging ECG system (MegaCart, Siemens-Elema, Solna, Sweden). Signal averaging was performed until the noise level was <0.5 V at a filtered bandwidth of 40 to 250 Hz. Timedomain analysis was conducted using the method of Simson [13]. Parameters were measured when the vector magnitude (X2 + Y2 + Z2)1/2 exceeded the baseline noise by >3 SD [13]. The following parameters were measured: (a) duration of the filtered QRS (f-QRS); (b) duration of the terminal QRS <40 V (LAS40); and (c) the root-mean-square amplitude of the terminal 40 ms (RMS40). In this study, signal-averaging ECG was considered to demonstrate LPs if the study had two of the following three characteristics: f-QRS >120 ms, LAS40 >38 ms and RMS40 <20 V [14, 15].

Materials and methods Patient population We selected 56 patients with idiopathic DCM (left ventricular ejection fraction, LVEF, <45%) admitted to our institution with their first episode of congestive heart failure. A complete medical history was obtained and a physical

1058

Eur J Nucl Med Mol Imaging (2012) 39:10561064

Twenty-four-hour Holter ECG Twenty-four-hour Holter ECG monitoring with two leads was conducted using an ambulatory ECG recorder (DMC-4502; Nihon Koden, Tokyo, Japan). A modified Lowns classification [16, 17] was employed to evaluate the severity of ventricular arrhythmias, including premature ventricular contractions. Echocardiography Echocardiography was performed using the standard method in a blinded manner. Two independent and experienced echocardiographers who had no knowledge of the study, performed all measurements. Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and LVEF were calculated using the modified method of Simpson [18].
123

were evaluated using the unpaired t-test. NYHA functional class and Lowns classification were compared using the Wilcoxon matched pairs signed ranks test. The relationship between Lowns classification and 123I-MIBG parameters was assessed using the Spearmans rank correlation coefficient (rs) Logistic regression was used to evaluate which 123IMIBG parameter (TDS, H/M ratio or WR) contributed to the incidence of sudden death events. Likewise, logistic regression was used to compare the incidence of sudden death between groups, adjusting for age at baseline.

Results Clinical characteristics and late ventricular potentials The 56 patients, 24 (42.9%) showed evidence of LPs (LPpositive group). The remaining 32 patients comprised the LP-negative group. The clinical characteristics of patients in the LP-positive and LP-negative groups are summarized in Table 1. There were no significant differences in clinical characteristics and medications between the two groups. The echocardiographic LVEDV, LVESV and LVEF, as well as plasma BNP concentrations, and NYHA functional class were similar in the two groups. Sudden death events The average follow-up time was 4.5 years, and there were nine sudden deaths among the 56 patients (16.1%). The sudden death events occurred an average of 2.931.45 years after discharge from our institution. On logistic regression analysis, the incidence of sudden cardiac death was 33.3% (8/24) in the LP-positive group, and 3.1% (1/32) in the LPnegative group (p<0.001). Incidence of ventricular arrhythmias based on Lowns classification Table 2 summarizes the incidences of ventricular arrhythmias in the LP-negative and LP-positive groups. Based on Lowns classification, the incidence of ventricular arrhythmias was significantly higher in the LP-positive group than in the LP-negative group (p<0.001). Cardiac
123

I-MIBG imaging

The 123I-MIBG imaging method has already been described in detail [19, 20]. Briefly, 123I-MIBG was obtained from a commercial source (FUJIFILM RI Pharma, Tokyo, Japan). At 15 min and 4 h after injection, anterior planar and SPECT images were obtained with a single-head gamma camera (Millennium MPR; GE Medical Systems, Waukesha, WI). The heart/mediastinum count (H/M) ratio was determined from the anterior planar delayed 123I-MIBG image. The washout rate (WR) was calculated from early and delayed planar images. Regional tracer uptake was assessed semiquantitatively using a five-point scoring system (0 0 normal to 4 0 no uptake) in 17 segments on the delayed SPECT image as recommended by the American Heart Association [21]. The total defect score (TDS) was calculated as the sum of all defect scores. Plasma BNP concentrations Blood samples were collected into test tubes containing EDTA after the subject had rested in the supine position for at least 30 min. Plasma was separated by centrifugation and then frozen at 84C. Then the plasma BNP was measured with a specific immunoradiometric assay for human BNP using a commercially available kit (Shionogi, Osaka, Japan), as previously reported [22, 23]. Statistical analysis Statistical analyses were performed using SPSS 16.0 for Windows (SPSS, Chicago, IL). Numerical results are expressed as means (SD). In all analyses, p<0.05 was considered statistically significant. Categorical data were compared using two-sided chi-square tests and differences between continuous variables

I-MIBG scintigraphic findings

The TDS, H/M ratio, and WR are shown in Fig. 1. TDS was significantly higher in the LP-positive group than in the LPnegative group (358 vs. 286, p<0.005). Segmental analysis showed impaired uptake in the inferior wall in both groups and while this was more severe in the LP-positive group, the

Eur J Nucl Med Mol Imaging (2012) 39:10561064 Table 1 Clinical characteristics of the DCM patients. Values are meansSD or number (%) Age (years) Gender (male) Height (cm) Weight (kg) Heart rate (beats/min) Systolic pressure (mmHg) Diastolic pressure (mmHg) NYHA functional class II III Hypertension Dyslipidaemia Echocardiographic data LVEDV (ml) LVESV (ml) LVEF(%) Plasma BNP (pg/ml) Medication Angiotensin-converting enzyme inhibitor/ angiotensin receptor blocker Diuretics Mineralocorticoid receptor antagonist
a

1059

LP positive (n024) 5812 17 (71%) 16111 5810 718 12012 7010 10 (42%) 14 (58%) 3 (13%) 4 (17%) 20357 14563 309 258232 23 (96%) 24 (100%) 18 (75%) 22 (92%) 12 (50%)

LP negative (n032) 6010 23 (72%) 16312 6012 7310 12116 7111 15 (47%) 17 (53%) 4 (13%) 4 (13%) 19750 13652 328 252236 30 (94%) 31 (97%) 23 (72%) 29 (91%) 9 (28%)

p value 0.511 0.514 0.520 0.499 0.424 0.798 0.728 0.454 0.903 0.564 0.716 0.570 0.375 0.925 0.731 0.884 0.965 0.735 0.139

Use of beta-blocker and antiarrhythmic agents, as scored at the last follow-up visit.

Beta-blockera Antiarrhythmic agentsa

difference was not statistically significant. The H/M ratio was significantly lower in the LP-positive than that in the LPnegative group (1.570.23 vs. 1.780.20, p<0.005). Furthermore, WR was significantly higher in the LP-positive group than in the LP-negative group (60 14% vs. 46 12%, p < 0.001). Relationship between Lowns classification and MIBG parameters According to Spearmans rank correlation coefficient analysis, there was a significant correlation between Lowns
Table 2 Incidence of ventricular arrhythmias based on Lowns classification. Values are numbers (%) Lowns grade I II III IVa IVb LP positive (n024) 1 2 5 7 9 (4%) (8%) (21%) (29%) (38%) LP negative (n032) 12 (38%) 10 (31%) 5 (16%) 3 (9%) 2 (6%) p value

classification and WR evaluated by 123I-MIBG (rs 00.837, p<0.001; Fig. 2). Furthermore, there was significant correlation between Lowns classification and TDS (rs 00.756, p<0.005) and H/M ratio (rs 00.623, p<0.01). However, WR showed a more significant correlation than TDS and H/M ratio. Evaluation of sudden death
123

I-MIBG scintigraphic factors predicting

Table 3 shows the results of logistic regression analysis to assess factors predicting sudden death in patients with DCM. All three scintigraphic parameters were significant predictive factors. However, WR was more significant than TDS and H/M ratio. Incidence of sudden death events in each subgroup

<0.001

The two groups were compared using Wilcoxons matched pairs signed ranks test.

The LP-positive and LP-negative groups were also divided into subgroups based on WR. On the basis of our previous study [24], a high WR was defined as 50%, a cut-off value that was an incremental predictor of cardiac death including sudden death in patients with heart failure. In logistic regression analysis, the incidence of sudden death events in

1060 Fig. 1 Comparison of cardiac 123 I-MIBG scintigraphic findings. TDS 0 total defect score. H/M 0 heart/ mediastinum count. WR 0 washout rate
TDS p < 0.005 60 2.5 2.0 40 1.5 1.0 20 0.5 0 LP Positive LP Negative 0 LP Positive

Eur J Nucl Med Mol Imaging (2012) 39:10561064


H/M ratio p < 0.005 100 80 60 40 20 0 LP Negative LP Positive LP Negative WR p < 0.001

the LP-positive and high WR group was significantly higher than those in the LP-positive and low WR group (p<0.05), the LP-negative and high WR group (p<0.05), and the LPnegative and low WR group (p<0.01; Fig. 3). Case presentations Figure 4 shows a representative delayed anterior planar 123IMIBG image and signal-averaged electrocardiogram in a 56-year-old man in whom LPs were detected by signalaveraged ECG. The delayed H/M ratio and WR, as evaluated by 123I-MIBG imaging, were 1.34% and 74%, respectively. The f-QRS, LAS40 and RAM40 values were 170 ms, 64 ms and 5 V, respectively, indicating the presence of LPs. Figure 5 shows a representative delayed anterior planar 123 I-MIBG image and signal-averaged electrocardiogram in a 60-year-old woman in whom no LPs were detected. The delayed H/M ratio and WR, as evaluated by 123I-MIBG imaging, were 1.84% and 42%, respectively. The f-QRS, LAS40, and RAM40 values were 98 ms, 29 ms and 84 V,

respectively. These findings indicate that the patient had no LPs.

Discussion In several studies, sudden cardiac death has been found to account for 20% to 70% of total mortality in patients with heart failure [2527]. Approximately 60% of patients with idiopathic DCM develop complex ventricular ectopy and nonsustained VT [28]. The mechanisms and precise electrophysiological characteristics of ventricular tachyarrhythmias in patients with idiopathic DCM are unknown. In addition, several factors may generate ventricular arrhythmias in idiopathic DCM. These include neurohumoral activation, fibrosis leading to uncoupling of cells, ventricular hypertrophy, increase in cytosolic calcium, subendocardial ischaemia, electrolyte disturbances, and other factors. Moreover, reentrant ventricular arrhythmias are caused by slow conduction, unidirectional block, and uneven conduction. However, these findings are not generally observed in normal cardiac muscle, but rather are believed to occur in mixed areas of abnormal and normal cardiac muscle [29]. LPs are the result of delayed activation of the myocardium. Signal-averaged ECG, which can detect delayed activation, is used to identify DCM patients at increased risk of developing VT and sudden death [30, 31]. Denereaz et al. detected
Table 3 Contribution of MIBG parameters for sudden death events by logistic regression analysis
rs = 0.837 p < 0.001 II III IVa IVb

80 Washout Rate (%)

60

40

Hazard ratio TDS H/M ratio WR 9.561 0.068 22.022

95% confidence interval 2.22641.056 0.0110.419 3.012161.001

p value 0.003 0.004 0.002

20 Lowns Classification

Fig. 2 Correlation between the Lowns classification and WR evaluated by 123I-MIBG scintigraphy in 56 patients with DCM ( LP-positive group, LP-negative group)

Logistic regression analysis was used to calculate the Hazard ratio per 1SD increase in the level of each parameter

Eur J Nucl Med Mol Imaging (2012) 39:10561064


* ** **
41.2 Incidence of sudden death (%) 40

1061

30

20 14.3 10 0 0 LP(-) Low WR LP(-) High WR LP(+) Low WR LP(+) High WR 10.0

*: p<0.01, **: p<0.05, by logistic regression

Fig. 3 Incidence of sudden death in patients with DCM

LPs in 43% of their patients with DCM [31]. Similarly, LPs were seen in 24 of our 56 patients (42.9%). Furthermore, based on Lowns classification, the incidences of ventricular arrhythmias was significantly higher in the LP-positive than in the LP-negative group. Patients with DCM have been found to show impairment of presynaptic catecholamine reuptake, which can be assessed using the norepinephrine analogue 123I-MIBG and either planar

scintigraphy or SPECT [58]. Moreover, 123I-MIBG uptake is reportedly reduced in patients with malignant ventricular tachyarrhythmias [32, 33]. Schafers et al. reported that patients with right ventricular outflow tract tachycardia exhibit reduced 123 I-MIBG uptake in the posterior left ventricular wall, which indicates presynaptic dysfunction [32]. On the other hand, in our study, segmental analysis of SPECT images showed impaired uptake in the inferior wall in both groups and this was worse, though not significantly, in the LP-positive group. Further studies are necessary to clarify the relationship between segmental denervation and malignant ventricular tachyarrhythmias. Yukinaka et al. found that defect scores, as evaluated by 123IMIBG scintigraphy after myocardial infarction, were significantly greater in LP-positive than in LP-negative patients [34]. In their study, however, perfusion evaluated by 99mTc perfusion imaging did not differ between the two groups. Therefore, the presence of LPs may be more closely related to the denervated but viable myocardium (i.e. the mismatch area) in patients with myocardial infarction. In this study, we evaluated the 99mTc perfusion imaging in about half of the patients. However, the presence of LPs did not relate to the mismatch area (data not shown). Moreover, there were no relationships between perfusion defects and denervated myocardium in our DCM patients. Therefore, our findings demonstrate that the mechanisms associated with the presence of LPs in patients with myocardial infarction may be different from those in DCM patients.

Fig. 4 Delayed anterior planar 1123I-MIBG image (a) and signalaveraged electrocardiogram (b) from an LP-positive patient. The delayed H/M ratio and WR, as evaluated by 123I-MIBG image, were

1.34% and 74%, respectively. The f-QRS, LAS40 and RAM40 values were 170 ms, 64 ms and 5 V, respectively

1062

Eur J Nucl Med Mol Imaging (2012) 39:10561064

Fig. 5 Delayed anterior planar 1123I-MIBG image (a) and signalaveraged electrocardiogram (b) from an LP-negative patient. The delayed H/M ratio and WR, as evaluated by 123I-MIBG, were 1.84%

and 42%, respectively. The f-QRS, LAS40 and RAM40 values were 98 ms, 29 ms and 84 V, respectively

In our study, 123I-MIBG scintigraphic parameters (TDS, H/M ratio and WR) overlapped between the LP-positive and LP-negative groups, and it was difficult to utilize these parameters. Tamaki et al. reported that WR is the most powerful predictor of sudden cardiac death in the failing human heart, and this parameter may be associated with a change in arrhythmia mechanisms of re-entry, automaticity, which triggers activity that provokes lethal arrhythmias [35]. In this study, the difference in WR between the two groups was more marked than that of both TDS and H/M ratio, and this parameter was also the most significant factor predicting sudden death in our DCM patients. Furthermore, in the LP-positive patients with high WR, the incidence of sudden death events was higher than in other subgroups, and this finding was confirmed by logistic regression analysis. Accordingly, DCM patients who are both LP-positive and have WR 50% should receive with the most careful medical management. Study limitations The small number of DCM patients in this study limited the statistical power. In addition, signal-averaged ECG is known to be useful for prognostic evaluation of serious arrhythmic complications in patients with acute myocardial infarction [13]. However, LPs are not used widely in patients with nonischaemic congestive cardiomyopathy, as its positive predictive value has been shown not to be high

enough [36]. Another study has shown that 123I-MIBG scintigraphy, but not LPs, is a powerful predictor of sudden cardiac death in patients with cardiomyopathy [35]. Our findings demonstrate for the first time that LP positivity together with a high WR could be the incremental predictor of sudden death in DCM patients, but further studies are required to confirm this hypothesis in a larger group of patients. It is still unclear whether the presence of LPs impairs cardiac sympathetic nerve activity, or whether impaired cardiac sympathetic nerve activity leads to the presence of LPs in patients with nonischaemic heart failure. Therefore, further studies are necessary to clarify the relationship between the presence of LPs and impaired 123IMIBG uptake. Conclusion The TDS, H/M ratio and WR determined by cardiac 123IMIBG scintigraphy were worse in LP-positive than in LPnegative DCM patients. However, echocardiographic parameters, plasma BNP concentrations and NYHA functional class were similar in the two groups. Furthermore, in LP-positive patients with high WR, the incidence of sudden death events was higher than in other subgroups. These findings indicate that DCM patients who are LP-positive and have a high WR as evaluated by 123I-MIBG scintigraphy must be followed especially carefully during medical management.

Eur J Nucl Med Mol Imaging (2012) 39:10561064 Conflicts of interest None.

1063 16. Meinertz T, Hofmann T, Kasper W, Treese N, Bechtold H, Stienen U, et al. Significance of ventricular arrhythmias in idiopathic dilated cardiomyopathy. Am J Cardiol. 1984;53(7):9027. 17. Schillaci G, Verdecchia P, Borgioni C, Ciucci A, Zampi I, Battistelli M, et al. Association between persistent pressure overload and ventricular arrhythmias in essential hypertension. Hypertension. 1996;28(2):2849. 18. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2(5):35867. 19. Kasama S, Toyama T, Kumakura H, Takayama Y, Ichikawa S, Suzuki T, et al. Effects of nicorandil on cardiac sympathetic nerve activity after reperfusion therapy in patients with first anterior acute myocardial infarction. Eur J Nucl Med Mol Imaging. 2005;32(3):3228. 20. Kasama S, Toyama T, Kumakura H, Takayama Y, Ichikawa S, Suzuki T, et al. Effect of spironolactone on cardiac sympathetic nerve activity and left ventricular remodeling in patients with dilated cardiomyopathy. J Am Coll Cardiol. 2003;41(4):57481. 21. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105(4):53942. 22. Kasama S, Toyama T, Kumakura H, Takayama Y, Ichikawa S, Suzuki T, et al. Effects of candesartan on cardiac sympathetic nerve activity in patients with congestive heart failure and preserved left ventricular ejection fraction. J Am Coll Cardiol. 2005;45(5):6617. 23. Kasama S, Toyama T, Kumakura H, Takayama Y, Ichikawa S, Suzuki T, et al. Effects of perindopril on cardiac sympathetic nerve activity in patients with congestive heart failure: comparison with enalapril. Eur J Nucl Med Mol Imaging. 2005;32(8):96471. 24. Kasama S, Toyama T, Sumino H, Kumakura H, Takayama Y, Minami K, et al. Serial cardiac 123I-metaiodobenzylguanidine scintigraphic studies are more useful for predicting cardiac death than one-time scan in patients with chronic heart failure: sub-analysis of our previous report. Nucl Med Commun. 2010;31(9):80713. 25. The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;316(23):142935. 26. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325(5):293302. 27. Cohn JN, Johnson G, Ziesche S, Cobb F, Francis G, Tristani F, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med. 1991;325(5):30310. 28. De Maria R, Gavazzi A, Caroli A, Ometto R, Biagini A, Camerini F. Ventricular arrhythmias in dilated cardiomyopathy as an independent prognostic hallmark. Italian Multicenter Cardiomyopathy Study (SPIC) Group. Am J Cardiol. 1992;69(17):14517. 29. Josephson ME, Horowitz LN, Farshidi A. Continuous local electrical activity. A mechanism of recurrent ventricular tachycardia. Circulation. 1978;57(4):65965. 30. Poll DS, Marchlinski FE, Falcone RA, Josephson ME, Simson MB. Abnormal signal-averaged electrocardiograms in patients with nonischemic congestive cardiomyopathy: relationship to sustained ventricular tachyarrhythmias. Circulation. 1985;72(6):130813. 31. Denereaz D, Zimmermann M, Adamec R. Significance of ventricular late potentials in non-ischaemic dilated cardiomyopathy. Eur Heart J. 1992;13(7):895901.

References
1. Kjekshus J. Arrhythmias and mortality in congestive heart failure. Am J Cardiol. 1990;65(19):42I8I. 2. Packer M. Sudden unexpected death in patients with congestive heart failure: a second frontier. Circulation. 1985;72(4):6815. 3. Ikeda T, Sakata T, Takami M, Kondo N, Tezuka N, Nakae T, et al. Combined assessment of T-wave alternans and late potentials used to predict arrhythmic events after myocardial infarction. A prospective study. J Am Coll Cardiol. 2000;35(3):72230. 4. Steinberg JS, Berbari EJ. The signal-averaged electrocardiogram: update on clinical applications. J Cardiovasc Electrophysiol. 1996;7(10):97288. 5. Henderson EB, Kahn JK, Corbett JR, Jansen DE, Pippin JJ, Kulkarni P, et al. Abnormal I-123 metaiodobenzylguanidine myocardial washout and distribution may reflect myocardial adrenergic derangement in patients with congestive cardiomyopathy. Circulation. 1988;78(5 Pt 1):11929. 6. Schofer J, Spielmann R, Schuchert A, Weber K, Schluter M. Iodine-123 meta-iodobenzylguanidine scintigraphy: a noninvasive method to demonstrate myocardial adrenergic nervous system disintegrity in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol. 1988;12(5):12528. 7. Merlet P, Valette H, Dubois-Rande JL, Moyse D, Duboc D, Dove P, et al. Prognostic value of cardiac metaiodobenzylguanidine imaging in patients with heart failure. J Nucl Med. 1992;33(4):4717. 8. Nakata T, Wakabayashi T, Kyuma M, Takahashi T, Tsuchihashi K, Shimamoto K. Cardiac metaiodobenzylguanidine activity can predict the long-term efficacy of angiotensin-converting enzyme inhibitors and/or beta-adrenoceptor blockers in patients with heart failure. Eur J Nucl Med Mol Imaging. 2005;32(2):18694. 9. Akutsu Y, Kaneko K, Kodama Y, Li HL, Kawamura M, Asano T, et al. The significance of cardiac sympathetic nervous system abnormality in the long-term prognosis of patients with a history of ventricular tachyarrhythmia. J Nucl Med. 2009;50(1):617. 10. Boogers MJ, Borleffs CJ, Henneman MM, van Bommel RJ, van Ramshorst J, Boersma E, et al. Cardiac sympathetic denervation assessed with 123-iodine metaiodobenzylguanidine imaging predicts ventricular arrhythmias in implantable cardioverter-defibrillator patients. J Am Coll Cardiol. 2010;55(24):276977. 11. Yamazaki J, Muto H, Kabano T, Yamashina S, Nanjo S, Inoue A. Evaluation of beta-blocker therapy in patients with dilated cardiomyopathy clinical meaning of iodine 123-metaiodobenzylguanidine myocardial single-photon emission computed tomography. Am Heart J. 2001;141(4):64552. 12. Toyama T, Hoshizaki H, Seki R, Isobe N, Adachi H, Naito S, et al. Efficacy of amiodarone treatment on cardiac symptom, function, and sympathetic nerve activity in patients with dilated cardiomyopathy: comparison with beta-blocker therapy. J Nucl Cardiol. 2004;11(2):13441. 13. Simson MB. Use of signals in the terminal QRS complex to identify patients with ventricular tachycardia after myocardial infarction. Circulation. 1981;64(2):23542. 14. Nalos PC, Gang ES, Mandel WJ, Ladenheim ML, Lass Y, Peter T. The signal-averaged electrocardiogram as a screening test for inducibility of sustained ventricular tachycardia in high risk patients: a prospective study. J Am Coll Cardiol. 1987;9(3):53948. 15. Worley SJ, Mark DB, Smith WM, Wolf P, Califf RM, Strauss HC, et al. Comparison of time domain and frequency domain variables from the signal-averaged electrocardiogram: a multivariable analysis. J Am Coll Cardiol. 1988;11(5):104151.

1064 32. Schafers M, Wichter T, Lerch H, Matheja P, Kuwert T, Schafers K, et al. Cardiac 123I-MIBG uptake in idiopathic ventricular tachycardia and fibrillation. J Nucl Med. 1999;40(1):15. 33. Paul M, Schafers M, Kies P, Acil T, Schafers K, Breithardt G, et al. Impact of sympathetic innervation on recurrent life-threatening arrhythmias in the follow-up of patients with idiopathic ventricular fibrillation. Eur J Nucl Med Mol Imaging. 2006;33(8):86670. 34. Yukinaka M, Nomura M, Ito S, Nakaya Y. Mismatch between myocardial accumulation of 123I-MIBG and 99mTc-MIBI and late ventricular potentials in patients after myocardial infarction: association with the development of ventricular arrhythmias. Am Heart J. 1998;136(5):85967.

Eur J Nucl Med Mol Imaging (2012) 39:10561064 35. Tamaki S, Yamada T, Okuyama Y, Morita T, Sanada S, Tsukamoto Y, et al. Cardiac iodine-123 metaiodobenzylguanidine imaging predicts sudden cardiac death independently of left ventricular ejection fraction in patients with chronic heart failure and left ventricular systolic dysfunction: results from a comparative study with signal-averaged electrocardiogram, heart rate variability, and QT dispersion. J Am Coll Cardiol. 2009;53(5):42635. 36. Bax JJ, Kraft O, Buxton AE, Fjeld JG, Parzek P, Agostini D, et al. 123I-mIBG scintigraphy to predict inducibility of ventricular arrhythmias on cardiac electrophysiology testing: a prospective multicenter pilot study. Circ Cardiovasc Imaging. 2008;1(2):131 40.

Anda mungkin juga menyukai