Prediction of long-term cardiac events by 123I-MIBG imaging after acute myocardial infarction and reperfusion therapy

Document Type: Original Article


1 Department of Medical Examination, Ogaki Municipal Hospital, Ogaki, Japan

2 Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan


Objective(s): In heart failure, the heart-to-mediastinum (H/M) ratio of the delayed image and washout rate (WR) are well-known as a powerful cardiac event predictors. H/M ratio quantifies the accumulation rate of MIBG in the myocardium and WR quantifies reduction of meta-iodobenzylguanidine (MIBG) accumulation in the heart from the early planar image to the delayed planar images in the 123I-MIBG scintigraphy. The present study was conducted to estimate the role of the parameters of cardiac sympathetic imaging by 123I-MIBG myocardial scintigraphy in subacute phase of acute myocardial infarction (AMI) in the prediction of cardiac events, particularly in patients who are successfully responded to reperfusion therapy.
Methods: This study was conducted on 145 patients with initial AMI who underwent 123I-MIBG myocardial scintigraphy and myocardial single-photon emission computed tomography (SPECT) after successful response to reperfusion therapy. The 123I-MIBG myocardial scintigraphy was averagely performed 16±5.8 days after the onset of AMI. The early image was taken 15 min after the intravenous administration of 123I-MIBG. Three hours after 123I-MIBG administration, an anterior planar delayed SPECT image was obtained. The H/M ratio and WR were calculated based on planar images. In addition, the average WR, defect volume, and extent were calculated from the SPECT image. The end points of the cardiac event was defined as hospitalization due to unstable angina, heart failure progression, myocardial infarction recurrence, malignant arrhythmia and cardiac death.
Results: The follow-up period was 18.4±8.5 months on average, during which 38 (26.2%) cases experienced cardiac events. The results revealed a significant difference between the groups with and without cardiac events in terms of WR and WR (SPECT). Based on the multivariate analysis, WR was the only relevant factor predicting cardiac events. The cumulative event-free rate was significantly lower in the group with the delayed H/M ratio of < 1.74. The cumulative event-free rate were significantly lower in the groups with WR and WR (SPECT) more than 25% and 21.8%, respectively. There was no significant relationship between the cumulative event-free survival rate and the defect size.
Conclusion: In the subacute phase of myocardial infarction, the increased WR of 123I-MIBG from the myocardium in planar scintigraphy and SPECT is the predictor of heart failure and cardiac events such as myocardial infarction and recurrence of unstable angina.


Main Subjects

1. Schömig A, Fischer S, Kurz T, Richardt G, Schömig E. Nonexocytotic release of endogenous noradrenaline in the ischemic and anoxic rat heart: mechanism and metabolic requirements. Circulation Research. 1987;60(2):194-205.

2. Schömig A. Catecholamines in myocardial ischemia. Systemic and cardiac release. Circulation. 1990;82(3 Suppl):II13-22.

3. Wieland D. M, Swanson D. P, Brown L. E, Beierwaltes W. H. Imaging the adrenal medulla with an I-131- labeled antiadrenergic agent. Journal of nuclear medicine: official publication, Society of Nuclear Medicine. 1979;20(2):155-158.

4. Wieland D. M, Brown L. E, Rogers W. L, Worthington K. C, Wu J. L, Clinthorne N. H, et al. Myocardial imaging with a radioiodinated norepinephrine storage analog. Journal of nuclear medicine: official publication, Society of Nuclear Medicine. 1981;22(1):22-31.

5. Kline R. C, Swanson D. P, Wieland D. M, Thrall J. H, Gross M. D, Pitt B, Beierwaltes W. H. Myocardial imaging in man with I-123 meta-iodobenzylguanidine. Journal of Nuclear Medicine. 1981;22(2):129-132.

6. Merlet P, Valette H, Dubois-Randé J. L, Moyse D, Duboc D, Dove P, et al. Prognostic value of cardiac metaiodobenzylguanidine imaging in patients with heart failure. Journal of Nuclear Medicine. 1992;33(4):471-477.

7. Nakata T, Miyamoto K, Doi A, Sasao H, Wakabayashi T, Kobayashi H, et al. Cardiac death prediction and impaired cardiac sympathetic innervation assessed by MIBG in patients with failing and nonfailing hearts. Journal of Nuclear Cardiology. 1998;5(6):579-590

8. Nakata T, Wakabayashi T, Kyuma M, Takahashi T, Hashimoto A, Ogata H, et al. Prognostic implications of an initial loss of cardiac metaiodobenzylguanidine uptake and diabetes mellitus in patients with left ventricular dysfunction. Journal of cardiac failure. 2003;9(2): 113-121.

9. Yamada T, Shimonagata T, Fukunami M, Kumagai K, Ogita H, Hirata A, et al. Comparison of the prognostic value of cardiac iodine-123 metaiodobenzylguanidine imaging and heart rate variability in patients with chronic heart failure: a prospective study. Journal of the American College of Cardiology. 2003;41(2): 231-238.

10. Anastasiou-Nana M. I, Terrovitis J. V, Athanasoulis T, Karaloizos L, Geramoutsos A, Pappa L, et al. Prognostic value of iodine-123-metaiodobenzylguanidine myocardial uptake and heart rate variability in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. The American journal of cardiology.2 005;96(3):427-431.

11. Imamura Y, Ando H, Mitsuoka W, Egashira S, Masaki H, Ashihara T, et al. Iodine-123 metaiodobenzylguanidine images reflect intense myocardial adrenergic nervous activity in congestive heart failure independent of underlying cause. Journal of the American College of Cardiology. 1995;26(7):1594-1599.

12. Gill J. S, Hunter G. J, Gane G, Camm A. J. Heterogeneity of the human myocardial sympathetic innervation: in vivo demonstration by iodine 123-labeled meta-iodobenzylguanidine scintigraphy. American heart journal. 1993;126(2):390-398.

13. Nakajima K, Okuda K. How can I standardize MIBG myocardial scintigraphy? Heart failure management in PC era. 4th ed. Tokyo: FUJIFILM RI Pharma Co., Ltd.; 2011. P. 1-6.

14. Somsen G. A, Borm J. J, Dubois E. A, Schook M. B, Van E. D. W, Van E. R. Cardiac 123I-MIBG uptake is affected by variable uptake in reference regions: Implications for interpretation in clinical studies. Nuclear medicine communications. 1996;17(10):872-876.

15. Nakajima K, Okuda K, Yoshimura M, Matsuo S, Wakabayashi H, Imanishi Y, et al. Multicenter cross-calibration of I-123 metaiodobenzylguanidine heart-to-mediastinum ratios to overcome camera-collimator variations. Journal of Nuclear Cardiology. 2014;21(5):970-978.

16. Shiga K, Inoue T, Yamamoto K, Hirata T, Shima T, Miyazaki H, et al. Changes in myocardial mediastinal uptake ratio of MIBG depending on the location of the mediastinal ROI and the type of collimator. Eizō jōhō MEDICAL. 1996;28 (18):1120-1123

17. Kobayashi H. MIBG myocardial scintigraphy and prognosis of ischemic heart disease. In: MIBG Heart Failure Review Committee, editors. Heart failure and cardiac sympathetic function. Diagnostic imaging from pathophysiology to prognostic evaluation. 1st ed. Tokyo: MEDICAL VIEW Inc; 2002. p. 121-122

18. Imamura Y, Nishijima H, Fukuyama T. Utility of 123I-MIBG myocardial scintigraphy (MIBG) for prognostic prediction of chronic heart failure. Kakuigaku. 1997; 34 (8):631

19. Momose M, Kobayashi H, Iguchi N, Matsud, N, Sakomura Y, Kasanuki H, et al. Comparison of parameters of 123I-MIBG scintigraphy for predicting prognosis in patients with dilated cardiomyopathy. Nucl Med Commun. 1999;20:529-535.