incremental prognostic value of myocardial neuroadrenergic damage in patients with chronic congestive heart failure: an iodine-123 meta-iodobenzylguanidine scintigraphy study

Icd in primary prevention reduced mortality in patients with heart failure (hf); however, in about 80% of the icd recipients an event requiring a device intervention will never occur. thus, a reliable screening test included in a multiparametric approach to appropriately select patients to icd implantation is increasingly required. aim of the work was to assess if the iodine-123 meta-iodobenzylguanidine scintigraphy (123i-mibg) could be useful to identify patients with hf who would not benefit from the icd implantation because at low risk of arrhythmias. this is a retrospective multicentre study on patients undergoing 123i-mibg from 2012 to 2015. inclusion criteria where: age ≥ 18 years old, lvef ≤ 35% with idiopathic or ischemic heart disease, no previous malignant ventricular arrhythmias. patients were divided in two groups based on of late h/m < or ≥ 1.60 on 123i-mibg. primary end-point was occurrence of malignant arrhythmias. secondary end-point was occurrence of cardiac death and hospitalization for worsening hf. mace were mortality and malignant arrhythmias. eighty-one patients were enrolled (mean age: 69 years). on 123i-mibg, 54 patients had late h/m < 1.6 and 27 patients had late h/m ≥ 1.60. after a mean follow-up of 13.3 (± 9.7) months, the primary end-point occurred in 13 patients out of 81. no arrhythmias occurred in patients with h/m late ≥ 1.6. nineteen patients out of 20 with mace showed an h/m late < 1.6. death in group with h/m ≥ 1.6 occurred for worsening hf. a late h/m ≥ 1.60 showed a very high npv for arrhythmia (100%) and for death (96.3%). 123i-mibg imaging has the capability to identify patients at low risk of events.