Iodine-123 metaiodobenzylguanidine myocardial scintigraphy for prediction of response to β-blocker therapy in patients with dilated cardiomyopathy☆,☆☆,★
Section snippets
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
References (19)
- et al.
Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy
Lancet
(1993) - et al.
Which subgroup of patients with dilated cardiomyopathy would benefit from long-term beta-blocker therapy? A histologic viewpoint
J Am Coll Cardiol
(1993) - et al.
Predictors of systolic and diastolic improvement in patients with dilated cardiomyopathy treated with metoprolol
J Am Coll Cardiol
(1995) - et al.
Iodine-123 metaiodobenzylguanidine scintigraphy: a noninvasive method to demonstrate myocardial adrenergic nervous system disintegrity in patients with idiopathic dilated cardiomyopathy
J Am Coll Cardiol
(1988) - et al.
Metaiodobenzylguanidine imaging in diabetes mellitus: assessment of cardiac sympathetic denervation and its relation to autonomic dysfunction and silent myocardial ischemia
J Am Coll Cardiol
(1995) - et al.
Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy
Br Heart J
(1975) - et al.
Beneficial effects of long-term beta-blockade in congestive cardiomyopathy
Br Heart J
(1980) - et al.
Rationale for beta-adrenergic blocking drugs in cardiomyopathy
Am J Cardiol
(1985) - et al.
Increased β-receptor density and improved hemodynamic response to catecholamine stimulation during long-term metoprolol therapy in heart failure from dilated cardiomyopathy
Circulation
(1989)
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2014, Seminars in Nuclear MedicineCitation 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.
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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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0002-8703/97/$5.00 + 0 4/1/78081