Prediction of appropriate ICD therapy in patients with ischemic heart failure
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Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russian Federation
Received May 6, 2020; accepted Jul 27, 2020 doi:10.1007/s12350-020-02321-y
Background. Previous studies show inconsistent results on the role of innervation imaging (with I-123-mIBG) and perfusion imaging in predicting appropriate ICD therapy (aICDth). These studies included patients with both dilated and ischemic cardiomyopathy. This study compared the ability of 123I-mIBG imaging along with perfusion imaging (using thallium-199) to predict aICDth in patients with ischemic heart failure (IHF) in relation to indication for ICD implantation (primary vs. secondary prevention of sudden cardiac death (SCD)). Methods. mIBG/thallium SPECT imaging were performed before ICD implantation in 80 patients with IHF: 49 candidates for primary and 31 for secondary SCD prevention. Results. During a mean follow-up of 18 months, the imaging results could not predict patients with appropriate ICD therapy among patients with ICD implants for primary SCD prevention. While in the secondary SCD prevention group, those who received a ICDth had significantly larger summed scores of regional perfusion and innervation impairment, but not higher heartto-mediastinal mIBG ratio. The best results to predict aICDth were using mIBG summed score (cut-off point > 34%, sensitivity 72%, specificity 100%, AUC 0.909, P < 0.0001). Conclusion. The prognostic value of innervation and perfusion imaging in patients with IHF differ based on indication for ICD implantation (primary vs. secondary prevention of SCD). (J Nucl Cardiol 2020) Key Words: Heart Failure Æ SPECT Æ Cardiac innervation Æ Innervation tracers Æ Diagnostic and prognostic application
INTRODUCTION Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. Moreover, 25% of cardiovascular deaths happen suddenly. In particular,
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patients with prior myocardial infarction (MI) have an increased risk of sudden cardiac death (SCD).1,2 Currently, the use of an implantable cardioverterdefibrillator (ICD) is the main tool for SCD prevention.3 According to modern guidelines, the implantation of ICD for primary SCD prevention is recommended in All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Nagara Tamaki, MD. Reprint requests: Svetlana I. Sazonova, MD, Cardiology Research Institute, Tomsk National Research
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