Prognostic value of cardiac metaiodobenzylguanidine imaging and QRS duration in implantable cardioverter defibrillator patients with and without heart failure

Abstract Objective Impaired cardiac adrenergic activity has been demonstrated in heart failure (HF) and in diabetes mellitus (DM). [123I]I-metaiodobenzylguanidine (MIBG) enables assessment of the cardiac adrenergic nervous system. Tomographic imaging of the heart is expected to be superior to planar imaging. This study aimed to determine the quality and utility of MIBG SPECT in the assessment of cardiac innervation in postinfarction HF patients without DM, qualified for implantable cardioverter defibrillator (ICD) in primary prevention of sudden cardiac death. Methods Consecutive patients receiving an ICD on the basis of contemporary guidelines were prospectively included. Planar MIBG studies were followed by SPECT. The essential analysis was based on visual assessment of the quality of SPECT images (“high”, “low” or “unacceptable”). The variables used in the further analysis were late summed defect score for SPECT images and heart-to-mediastinum rate for planar images. MIBG images were assessed independently by two experienced readers. Results Fifty postinfarction nondiabetic HF subjects were enrolled. In 13 patients (26%), the assessment of SPECT studies was impossible. In addition, in 13 of 37 patients who underwent semiquantitative SPECT evaluation, the assessment was equivocal. Altogether, in 26/50 patients (52%, 95% confidence interval 38–65%), the quality of SPECT images was unacceptable or low and was limited by low MIBG cardiac uptake and by comparatively high, interfering MIBG uptake in the neighboring structures (primarily, in the lungs). Conclusions The utility of MIBG SPECT imaging, at least with conventional imaging protocols, in the qualification of postinfarction HF patients for ICD, is limited. In approximately half of the postinfarction HF patients, SPECT assessment of cardiac innervation can be impossible or equivocal, even without additional damage from diabetic cardiac neuropathy. The criteria predisposing the patient to good-quality MIBG SPECT are: high values of LVEF from the range characterizing the patients qualified to ICD (i.e., close to 35%) and left lung uptake intensity in planar images comparable to or lower than heart uptake.

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Remote heart failure management using a multiparameter implantable cardioverter-defibrillator alert: the multicentric RE-HEART registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.3465 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J De Juan Baguda ◽

J.J Gavira Gomez ◽

M Pachon Iglesias ◽

L Pena Conde ◽

J.M Rubin Lopez ◽

...

Keyword(s):

Heart Failure ◽

Implantable Cardioverter Defibrillator ◽

Median Duration ◽

Office Visit ◽

Active Phase ◽

Cardiac Resynchronization ◽

Office Visits ◽

Icd Implantation ◽

Cardioverter Defibrillator ◽

Clinical Events

Abstract Background The HeartLogic algorithm combines multiple implantable cardioverter-defibrillator (ICD)-based sensors into an index for prediction of impending heart failure (HF) decompensation. In patients with ICD and cardiac resynchronization therapy ICD remotely monitored at 13 Spanish centers, we analyzed the association between clinical events and HeartLogic alerts and we described the use of the algorithm for the remote management of HF. Methods The association between clinical events and HeartLogic alerts was studied in the blinded phase (from ICD implantation to alert activation – no clinical actions taken in response to alerts) and in the following active phase (after alert activation – clinicians automatically notified in case of alert). Results We enrolled a total of 215 patients (67±13 years old, 77% male, 53% with ischemic cardiomyopathy) with ICD (19%) or CRT-D (81%). The median duration of the blinded phase was 8 [3–12] months. In this phase, the HeartLogic index crossed the threshold value (set by default to 16) 34 times in 20 patients. HeartLogic alerts were associated with 6 HF hospitalizations and 5 unplanned in-office visits for HF. Five additional HeartLogic threshold crossings were not associated with overt HF events, but occurred at the time of changes in drug therapy or of other clinical events. The rate of unexplained alerts was 0.25 alert-patient/year. The median time spent in alert was longer in the case of HF hospitalizations than of in-office visits (75 [min-max: 30–155] days versus 39 [min-max: 5–105] days). The maximum HeartLogic index value was 38±15 in the case of hospitalizations and 24±7 in that of minor HF events. The median duration of the following active phase was 5 [2–10] months. After HeartLogic activation, 40 alerts were reported in 26 patients. Twenty-seven (68%) alerts were associated with multiple HF- or non-HF related conditions or changes in prescribed HF therapy. Multiple actions were triggered by these alerts: HF hospitalization (4), unscheduled in-office visits (8), diuretics increase (8), change in other cardiovascular drugs (5), device reprogramming (2), atrial fibrillation ablation (1), patient education on therapy adherence (2). The rate of unexplained alerts not followed by any clinical action was 0.13 alert-patient/year. These alerts were managed remotely (device data review and phone contact), except for one alert that generated an unscheduled in-office visit. Conclusions HeartLogic index was frequently associated with HF-related clinical events. The activation of the associated alert allowed to remotely detect relevant clinical conditions and to implement clinical actions. The rate of unexplained alerts was low, and the work required in order to exclude any impending decompensation did not constitute a significant burden for the centers. Funding Acknowledgement Type of funding source: None

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The Timing of Implantable Cardioverter-Defibrillator Implantation in Patients with Heart Failure

Current Cardiology Reports ◽

10.1007/s11886-012-0262-1 ◽

2012 ◽

Vol 14 (3) ◽

pp. 299-307 ◽

Cited By ~ 1

Author(s):

Nawaf S. Al-Majed ◽

Justin A. Ezekowitz

Keyword(s):

Heart Failure ◽

Implantable Cardioverter Defibrillator ◽

Cardioverter Defibrillator ◽

Implantable Cardioverter Defibrillator Implantation ◽

Patients With Heart Failure

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Heart Failure Patients Admitted With Elevated Cardiac Troponin Post Implantable Cardioverter-Defibrillator Firing Carry the Highest Mortality Rates

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2010.06.206 ◽

2010 ◽

Vol 16 (8) ◽

pp. S60

Author(s):

Emad F. Aziz ◽

Juan Pablo Cordova ◽

Balaji Pratap ◽

Manpreet Singh ◽

David Newman ◽

...

Keyword(s):

Heart Failure ◽

Implantable Cardioverter Defibrillator ◽

Cardiac Troponin ◽

Mortality Rates ◽

Cardioverter Defibrillator ◽

Heart Failure Patients

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Implantable Cardioverter Defibrillator in Heart Failure Patients with End-stage Renal Disease on Dialysis

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2015.08.077 ◽

2015 ◽

Vol 21 (10) ◽

pp. S158

Author(s):

Atsushi Suzuki ◽

Tsuyoshi Shiga ◽

Yuji Iwanami ◽

Ryuta Henmi ◽

Daigo Yagishita ◽

...

Keyword(s):

Heart Failure ◽

Renal Disease ◽

Implantable Cardioverter Defibrillator ◽

End Stage Renal Disease ◽

Cardioverter Defibrillator ◽

Heart Failure Patients ◽

Stage Renal Disease ◽

End Stage

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Abstract 5700: Worsening Renal Function and Arrhythmic Event in Implantable Cardioverter Defibrillator Patients with Nonischemic Heart Failure

Circulation ◽

10.1161/circ.118.suppl_18.s_988 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Atsushi Takahashi ◽

Tsuyoshi Shiga ◽

Daigo Yagishita ◽

Keisuke Futagawa ◽

Naoki Serizawa ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Renal Dysfunction ◽

Implantable Cardioverter Defibrillator ◽

Shock Therapy ◽

Electrical Storm ◽

Icd Implantation ◽

Cardioverter Defibrillator ◽

Arrhythmic Event ◽

Icd Shock

Purpose: Implantable Cardioverter Defibrillator (ICD) prevents sudden cardiac death in high risk patients with heart failure (HF). Worsening renal function (WRF) is associated with mortality in patients with myocardial infarction or HF, but its effect on lethal arrhythmia is unknown. We evaluated the influence of WRF on the occurrence of arrhythmic events in patients with nonischemic HF and ICD. Methods: A total of 286 nonischemic HF patients who underwent ICD implantation between 1990 and 2007 were studied. Estimated Glomerular Filtration Rate (eGFR) was calculated using the Modification of Diet in Renal Disease. Renal dysfunction was defined as eGFR <60mL/min/1.73m 2 and WRF was defined as 15mL/min/1.73m 2 per year. Differences in arrhythmia recurrences according to the eGFR and WRF were compared by Kaplan-Meier survival curves. Results: During a mean follow-up time of 2.2+/−1.0 years, 94 (33%) of 286 patients (mean age; 57+/−15 years, 72% male) experienced appropriate ICD shock therapy. There was a significantly higher cumulative rate of appropriate ICD shock therapy (p<0.05) and electrical storm (p<0.05) in patients with renal dysfunction than others. The patients with renal dysfunction at baseline experience WRF more frequently than other patients (53% vs. 23%, respectively, p<0.01). After correcting for age, sex, left ventricular ejection fraction (LVEF), indication for ICD implantation, and use of beta-blockers in a Cox regression model, WRF was still an independent predictor of the time to first appropriate shock (HR 2.21, 95% CI 1.32–3.69, p<0.05) and electrical storm (HR 2.22, 95% CI 1.19 – 4.13, p<0.05). The result of subgroup analysis of 147 patients with low LVEF (LVEF<35%) indicated that the patients with WRF experienced electrical storms more frequently (p<0.05). Conclusion: WRF is associated with increased rate of arrhythmic event in nonischemic HF patients. Especially, those patients with low LVEF and WRF experience more frequent ICD shocks.

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