How to use myocardial ¹²³I-MIBG scintigraphy in chronic heart failure

Excerpt

Cardiac sympathetic neuronal function and activity can be assessed noninvasively by the use of ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG), an analogue of norepinephrine [1]. In the past two decades, a large number of investigators have demonstrated decreased myocardial ¹²³I-MIBG uptake in patients with chronic heart failure (CHF) and have shown that those with the lowest uptake tend to have the poorest prognosis [2‐12]. There have also been findings suggesting that abnormalities of myocardial ¹²³I-MIBG uptake may be predictive of increased risk of ventricular arrhythmia and sudden cardiac death [13, 14]. One factor that has constrained acceptance of cardiac ¹²³I-MIBG imaging as a clinical management tool in heart failure has been the variability of the technical aspects of the procedure. Although most reports include the heart-to-mediastinum (H/M) ratio as the measure of myocardial uptake, the methods used to obtain this parameter have shown considerable variation. However, the influence of procedural and acquisition parameters on the reproducibility of this measurement technique have only occasionally been considered. …