Iodine-123 metaiodobenzylguanidine myocardial scintigraphy for prediction of response to β-blocker therapy in patients with dilated cardiomyopathy,☆☆,

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Abstract

This study was performed to evaluate whether iodine-123 metaiodobenzylguanidine (MIBG) myocardial scintigraphy could predict the response to β-blocker therapy in patients with nonischemic dilated cardiomyopathy (DCM). β-Blocker therapy is effective in some patients with DCM. MIBG myocardial scintigraphy has also been suggested to be useful in evaluating the severity of myocardial damage in DCM. However, no data exist on whether MIBG imaging can be used to predict which patients with DCM will respond to β-blocker therapy. We prospectively evaluated whether MIBG myocardial imaging was useful in predicting responses to β-blocker therapy in patients with DCM. MIBG imaging was performed in 45 patients with DCM (35 men, 10 women, aged 13 to 68 years) before the start of bisoprolol. The heart to mediastinum (H/M) MIBG uptake ratio was evaluated on initial and delayed images, and the percent washout rate of myocardial MIBG was also obtained from these data. Of the 45 patients, 30 (67%) responded to β-blocker therapy, whereas 2 were resistant and 13 showed progression of heart failure or died of heart failure. By logistic regression analysis, the H/M uptake ratio on delayed images was seen to be a good predictor of the response to β-blocker therapy with a threshold of 1.7 (sensitivity = 91%, specificity = 92%, accuracy = 91%, positive and negative predictive value = 97% and 80%, respectively). These results indicate that an H/M ratio >1.7 on the delayed MIBG myocardial scintigraphic images provides a useful indication of whether patients with DCM will respond to β-blocker therapy. (Am Heart J 1997;133:353-8.)

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Study patients

Forty-five patients (35 men and 10 women, ranging in age from 13 to 68 years) with congestive heart failure were included in this study. All patients had the diagnosis of nonischemic DCM made on the basis of a complete evaluation that included electrocardiography, chest roentgenography, echocardiography, cardiac catheterization, and endomyocardial biopsy. Twenty were in New York Heart Association (NYHA) functional class III and 25 were in class IV; all were treated with digitalis, diuretics,

Response of bisoprolol

Bisoprolol was discontinued because of worsening heart failure in 13 patients either during the increase in the dosage or after they were receiving the full dose. Seven of the 13 patients died of heart failure despite discontinuing bisoprolol. At 4 months after reaching the full dose of bisoprolol, 13 of the remaining 32 patients responded to it, but 19 were considered resistant to it. Among those 19 patients, 17 showed response at 8 months, but 2 remained resistant. Thus 30 patients responded

DISCUSSION

In patients with severe heart failure refractory to medical treatment, especially in young patients, heart transplantation has been offered as a therapeutic option. However, after the induction of β-blocker therapy in patients with heart failure, the number of patients requiring heart transplantation has decreased, as indicated in a therapeutic trial of β-blocking agents in patients with idiopathic DCM. 6 Recent multicenter trials have revealed that bisoprolol reduces mortality in patients with

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    Citation Excerpt :

    Sometimes, however, an improved HMR does not parallel an increase in LVEF186 nor an improvement in patient functional capacity,189 indicating that HMR portrays an aspect of a patient׳s condition different from other findings. In terms of guidance of medical therapy use, investigations with β-blockers have shown that 123I-mIBG imaging does not provide sufficient separation between those who do or do not benefit.190,191 Given that standard HF medical therapies are relatively convenient, inexpensive, and low risk, it is unlikely that 123I-mIBG image results would preclude their use.

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From the Third Division, Department of Internal Medicine and Department of Radiology, Osaka Medical College, Takatsuki City.

☆☆

Reprint requests: Michihiro Suwa, MD, The Third Division, Department of Internal Medicine, Osaka Medical College, 2-7, Daigaku-cho, Takatsuki City, Osaka, 569-MZ, Japan.

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