Impact of concomitant medication use on myocardial 123I-mIBG imaging results in patients with heart failure

Arnold F. Jacobson, Susan White, Mark I. Travin, Carol Tseng

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Abstract

Introduction Medications that interfere with sympathetic neuronal norepinephrine uptake and storage, such as neuropsychiatrics (NP) and sympathomimetic amines, are most likely to affect cardiac uptake of iodine-123 metaiodobenzylguanidine (123I-mIBG). The present study examined these and other medications reported to affect 123I-mIBG uptake using measurements of cardiac 123I-mIBG uptake on the heart failure (HF) patients in the ADMIRE-HF extension (X) study. Methods Baseline concomitant medications taken by the 961 HF patients were categorized into five groups: calcium channel blockers, NP medications, β agonists and sympathomimetics, α antagonists, and other antihypertensives. NP medications were further subcategorized into those expected to have high and low impact on norepinephrine transporter (NET) function. Myocardial 123I-mIBG heart/mediastinum (H/M) uptake ratios on 4 h planar images were compared among the groups. Impact of medication group on the prognostic value of the H/M ratio for all-cause (AC) and cardiac death during a median 2-year follow-up was also examined. Results A total of 283 (29%) patients were using at least one calcium channel blocker, NP medication, or β agonist or sympathomimetic. These patients had a lower mean H/M ratio than the other study patients (1.42 ± 0.20 vs. 1.45 ± 0.20; P=0.022). However, the 2-year AC mortality rates in the two groups were the same [11.3% (95% confidence interval: 7.5 15.2%) vs. 11.8% (95% confidence interval: 9.2 14.4%)]. In terms of medication categories, there were no significant differences in the mean H/M ratios between patients who did and did not use NP medications, β agonists, calcium channel blockers, and α antagonists. Across all categories, patients with H/M ratio greater than or equal to 1.60 had lower AC and cardiac mortality. Patients using higher potency (for NET inhibition) NP medications had significantly lower H/M ratio values, but the prognostic significance of H/M ratio greater than or equal to 1.60 was unchanged. Conclusion Only a small number of higher potency NETinhibiting NP medications have a measurable effect on the results of 123I-mIBG myocardial imaging. There appears to be no basis for restricting the use of calcium channel blockers and β agonist respiratory medications in HF patients referred for cardiac 123I-mIBG imaging.

Original languageEnglish (US)
Pages (from-to)141-148
Number of pages8
JournalNuclear Medicine Communications
Volume38
Issue number2
DOIs
StatePublished - 2017

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Keywords

  • I-mIBG
  • Concomitant medications
  • Myocardial imaging
  • Norepinephrine transporter

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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