Highlights
- •Heart failure (HF) is frequently associated with comorbidities, which have been individually associated with reduced cardiac adrenergic innervation and higher risk of major arrhythmic events. However, very comorbid HF patients are less likely to experience fatal arrhythmias.
- •We assessed the impact of 7 comorbidities/conditions (smoking, chronic obstructive pulmonary disease, diabetes mellitus, peripheral artery disease, atrial fibrillation, chronic ischemic heart disease and chronic kidney disease) on cardiac adrenergic innervation, through 123I-mIBG imaging, in a population of patients with systolic HF.
- •Although at univariate analysis highly comorbid patients presented reduced mean values of late heart to mediastinum (H/M) ratio, multiple regression analysis revealed that the number of comorbidities was not associated with mIBG parameters of cardiac denervation.
Abstract
Introduction
Heart failure (HF) is frequently associated with comorbidities. 123I-metaiodobenzylguanidine (123I-mIBG) imaging constitutes an effective tool to measure cardiac adrenergic innervation
and to improve prognostic stratification in HF patients, including the risk of major
arrhythmic events. Although comorbidities have been individually associated with reduced
cardiac adrenergic innervation, thus suggesting increased arrhythmic risk, very comorbid
HF patients seem to be less likely to experience fatal arrhythmias. We evaluated the
impact of the number of comorbidities on cardiac adrenergic innervation, assessed
through 123I-mIBG imaging, in patients with systolic HF.
Methods
Patients with systolic HF underwent clinical examination, transthoracic echocardiography
and cardiac 123I-mIBG scintigraphy. The presence of 7 comorbidities/conditions (smoking, chronic
obstructive pulmonary disease, diabetes mellitus, peripheral artery disease, atrial
fibrillation, chronic ischemic heart disease and chronic kidney disease) was documented
in the overall study population.
Results
The study population consisted of 269 HF patients with a mean age of 66±11 years,
a left ventricular ejection fraction (LVEF) of 31±7%, and 153 (57%) patients presented
≥3 comorbidities. Highly comorbid patients presented a reduced late heart to mediastinum
(H/M) ratio, while no significant differences emerged in terms of early H/M ratio
and washout rate. Multiple regression analysis revealed that the number of comorbidities
was not associated with mIBG parameters of cardiac denervation, which were correlated
with age, body mass index and LVEF.
Conclusion
In systolic HF patients, the number of comorbidities is not associated with alterations
in cardiac adrenergic innervation. These results are consistent with the observation
that very comorbid HF patients suffer lower risk of sudden cardiac death.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global Public Health Burden of Heart Failure.Card Fail Rev. 2017; 03: 7https://doi.org/10.15420/cfr.2016:25:2
- Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association.Circulation. 2019; 139https://doi.org/10.1161/CIR.0000000000000659
- Epidemiology, Pathophysiology, and Prognosis of Heart Failure in Older Adults.Heart Fail Clin. 2017; 13: 417-426https://doi.org/10.1016/j.hfc.2017.02.001
- The Sympathetic Nervous System in Heart Failure. Physiology, Pathophysiology, and Clinical Implications.J Am Coll Cardiol. 2009; 54: 1747-1762https://doi.org/10.1016/j.jacc.2009.05.015
- The comparative prognostic value of plasma neurohormones at baseline in patients with heart failure enrolled in Val-HeFT.Eur Heart J. 2004; 25: 292-299https://doi.org/10.1016/j.ehj.2003.10.030
- Prognostic Value of Lymphocyte G Protein-Coupled Receptor Kinase-2 Protein Levels in Patients with Heart Failure.Circ Res. 2016; 118: 1116-1124https://doi.org/10.1161/CIRCRESAHA.115.308207
- Transcardiac increase in norepinephrine and prognosis in patients with chronic heart failure.Eur J Heart Fail. 2008; 10: 1208-1214https://doi.org/10.1016/j.ejheart.2008.09.011
- 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur J Heart Fail. 2016; 18: 891-975https://doi.org/10.1002/ejhf.592
- Cost-Effectiveness Analysis of Iodine-123 Meta-Iodobenzylguanidine Imaging for Screening Heart Failure Patients Eligible for an Implantable Cardioverter Defibrillator in the USA.Appl Health Econ Health Policy. 2016; 14: 361-373https://doi.org/10.1007/s40258-016-0234-5
- Prevalence and importance of comorbidities in patients with heart failure.Curr Heart Fail Rep. 2012; 9: 354-362https://doi.org/10.1007/s11897-012-0110-z
- Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: A systematic review and meta-analysis.Int J Cardiol. 2015; 196: 98-106https://doi.org/10.1016/j.ijcard.2015.05.180
- Impact of Diabetes on Cardiac Sympathetic Innervation in Patients With Heart Failure: A 123I meta-iodobenzylguanidine (123I MIBG) scintigraphic study.Diabetes Care. 2013; 36: 2395-2401https://doi.org/10.2337/dc12-2147
- Cardiac Autonomic Neuropathy in Patients with Chronic Renal Failure on Hemodialysis.Nephron. 2000; 84: 312-319https://doi.org/10.1159/000045605
- Sleep-disordered breathing, impaired cardiac adrenergic innervation and prognosis in heart failure.Heart. 2016; 102: 1813-1819https://doi.org/10.1136/heartjnl-2015-309215
- Outcomes of Implantable Cardioverter-Defibrillator Use in Patients With Comorbidities: Results From a Combined Analysis of 4 Randomized Clinical Trials.JACC Hear Fail. 2014; 2: 623-629https://doi.org/10.1016/J.JCHF.2014.06.007
- Risk Stratification for Primary Implantation of a Cardioverter-Defibrillator in Patients With Ischemic Left Ventricular Dysfunction.J Am Coll Cardiol. 2008; 51: 288-296https://doi.org/10.1016/j.jacc.2007.08.058
- Impact of body mass index on cardiac adrenergic derangement in heart failure patients: a 123I-mIBG imaging study.Eur J Nucl Med Mol Imaging. 2019; : 1-9https://doi.org/10.1007/s00259-019-04658-0
- Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28 (e14): 1-39https://doi.org/10.1016/j.echo.2014.10.003
Rengo G, Pagano G, Vitale DFDF, Formisano R, Komici K, Petraglia L, et al. Impact of aging on cardiac sympathetic innervation measured by 123I-mIBG imaging in patients with systolic heart failure 2016;43:2392–400. https://doi.org/10.1007/s00259-016-3432-3.
- Impact of diabetes on cardiac sympathetic innervation in patients with heart failure: a 123I meta-iodobenzylguanidine (123I MIBG) scintigraphic study.Diabetes Care. 2013; 36https://doi.org/10.2337/dc12-2147
- Proposal for standardization of 123I-metaiodobenzylguanidine (MIBG) cardiac sympathetic imaging by the EANM Cardiovascular Committee and the European Council of Nuclear Cardiology.Eur J Nucl Med Mol Imaging. 2010; 37: 1802-1812https://doi.org/10.1007/s00259-010-1491-4
- Observer reproducibility of results from a low-dose 123I-metaiodobenzylguanidine cardiac imaging protocol in patients with heart failure.Eur J Nucl Med Mol Imaging. 2013; 40: 1549-1557https://doi.org/10.1007/s00259-013-2461-4
- β-Adrenergic Receptor Signaling and Heart Failure: From Bench to Bedside.Heart Fail Clin. 2019; 15: 409-419https://doi.org/10.1016/j.hfc.2019.02.009
- Myocardial Iodine-123 Meta-Iodobenzylguanidine Imaging and Cardiac Events in Heart Failure. Results of the Prospective ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) Study.J Am Coll Cardiol. 2010; 55: 2212-2221https://doi.org/10.1016/j.jacc.2010.01.014
- The clinical course of patients with implantable cardioverter-defibrillators: Extended experience on clinical outcome, device replacements, and device-related complications.Hear Rhythm. 2015; 12: 1169-1176https://doi.org/10.1016/j.hrthm.2015.02.035
- Cardiac 123I-mIBG scintigraphy is associated with freedom of appropriate ICD therapy in stable chronic heart failure patients.Int J Cardiol. 2017; 248: 403-408https://doi.org/10.1016/j.ijcard.2017.08.003
- Selecting Patients With Nonischemic Dilated Cardiomyopathy for ICDs: Myocardial Function, Fibrosis, and What's Attached?.J Am Coll Cardiol. 2017; 70: 1228-1231https://doi.org/10.1016/j.jacc.2017.07.748
- Comorbidity health pathways in heart failure patients: A sequences-of-regressions analysis using cross-sectional data from 10,575 patients in the Swedish Heart Failure Registry.PLoS Med. 2018; 15e1002540https://doi.org/10.1371/journal.pmed.1002540
Article info
Publication history
Published online: January 20, 2021
Accepted:
January 7,
2021
Received in revised form:
December 28,
2020
Received:
September 21,
2020
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
