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Predictive value of cardiac autonomic indexes and MIBG washout in ICD recipients with mild to moderate heart failure

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Abstract

Objective

We aimed at evaluating the combined use of heart rate variability (HRV), baroreflex sensitivity (BRS), and MIBG imaging in the risk stratification for sudden cardiac death (SCD) of patients with mild to moderate heart failure.

Methods

Twenty-five patients (17 male and 8 female, mean age 63 ± 5 years, mean LVEF 36 ± 3%) with a recently implanted defibrillator (ICD) and mild (NYHA I-II) heart failure due to either ischemic (n = 15) or dilated (n = 10) cardiomyopathy were studied. One week after ICD implantation they underwent (a) baroreflex sensitivity (BRS) evaluation to bolus phenylephrine by the Oxford method, (b) 24-h heart rate variability (HRV) assessment, and (c) MIBG imaging. The mean patient follow-up was 32 ± 10 months. Simple correlation and stepwise multiple regression analysis was performed to evaluate (a) if the number of sustained ventricular tachycardia (cycle length <330 ms) or fibrillation episodes per month is related to one or more of MIBG, BRS, and HRV indexes and (b) if MIBG % washout is related to HRV and/or BRS.

Results

The frequency of fast ventricular arrhythmic episodes (FVAE) demonstrated an inverse relation to BRS (p < 0.0001), rMSSD (p = 0.001), and pNN50 (p = 0.0034), while it was positively related to LF (p < 0.0001) and MIBG % washout (p = 0.001). BRS, LF, rMSSD, and MIBG washout were also independent predictors of FVAE. MIBG washout was related to only one HRV marker (SDNN-I, p < 0.0001), while no correlation was observed with BRS.

Conclusions

In ICD recipients with well-compensated heart failure, autonomic markers derived from BRS, HRV, and MIBG studies are related to FVAE. These markers have limited inter-dependency and constitute useful means for SCD risk stratification in this subgroup of patients.

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Authors and Affiliations

  1. Department of Nuclear Cardiology, Onassis Cardiac Surgery Center, Athens, Greece

    Maria Koutelou

  2. Zoodoxou Pigis Str. 54, Melissia, 151-27, Athens, Greece

    Athanasios Katsikis

  3. 2nd Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece

    Athanasios Katsikis, Efthimios Livanis & Vasilios Voudris

  4. 2nd Cardiology Department, Attikon Hospital, Athens, Greece

    Peny Flevari & Dimitrios Kremastinos

  5. Cardiology Department, Eric Dynan Hospital, Athens, Greece

    George Theodorakis

  6. Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece

    Michalis Georgiadis

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  1. Maria Koutelou
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Correspondence to Athanasios Katsikis.

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Koutelou, M., Katsikis, A., Flevari, P. et al. Predictive value of cardiac autonomic indexes and MIBG washout in ICD recipients with mild to moderate heart failure. Ann Nucl Med 23, 677–684 (2009). https://doi.org/10.1007/s12149-009-0289-6

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  • DOI: https://doi.org/10.1007/s12149-009-0289-6

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