- 123I-mIBG assessed cardiac sympathetic activity: standardizing towards clinical implementation
- Award date
- 28 March 2017
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
In part I of this thesis several aspects are studied related to standardization of image acquisition. High-energy photon emission of 123I leads to penetration of collimator septa and subsequently affects the accuracy of the H/M ratio. It is therefore apparent that differences in collimator, essential in nuclear medicine techniques, influence 123I-mIBG myocardial derived parameters. To correct for these differences in collimators a European cross-calibration study was performed. This cross-calibration enables a better comparison between institutions which is important for identifying appropriate thresholds for differentiating high and low risk heart failure patients. Standardizing the post-acquisition processing of planar cardiac 123I-mIBG scintigraphy is also essential. Therefore the impact of differences in region of interest (ROI) placement (e.g. a fixed mediastinal ROI) on the accuracy were studied. In addition different patient factors such as polymorphism of the SLC6A2 gene encoding for the NE re-uptake, renal function and the relationship between changes in heart (H) and mediastinal (M) counts and the change in vascular 123I-mIBG activity were studied.
Part II evaluates the prognostic value of cardiac 123I-mIBG scintigraphy in CHF. First, a meta-analysis using individual patient data from 6 different published studies looked at the prognostic value of cardiac 123I-mIBG scintigraphy. Furthermore the relationship between cardiac sympathetic activity and inflammation in stable CHF and their prognostic value was evaluated. Finally, an European multicentre study was performed to study cardiac 123I-mIBG scintigraphy in stable CHF patients eligible for ICD implantation for primary prevention with the goal to optimize the current selection criteria for this specific indication.
Part III describes 123I-mIBG scintigraphy assessed cardiac sympathetic activity in patients with 22q11.2 deletion syndrome which affects the degradation of NE, the neurotransmitter of the cardiac sympathetic system. Furthermore we discussed the possible pathophysiology and the potential role of cardiac 123I-mIBG scintigraphy in Tako-tsubo cardiomyopathy.
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