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A Method of Dynamic Analysis of Iodine-123-Metaiodobenzylguanidine Scintigrams in Cardiac Mechanical Overload Hypertrophy and Failure

McGill University and the Departments of Cardiology at the Montreal General Hospital, Royal Victoria Hospital, and Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada

Correspondence: For correspondence or reprints contact: Dr. Mark Rabinovitch, Division of Cardiology, Montreal General Hospital, 1650 Cedar Ave., Montreal, PQ H3G 1A4, Canada.

ABSTRACT

Cardiac sympathetic neuronal degeneration accompanies mechanical overload heart failure. We hypothesized that sympathetic nerve and myocyte failure share a common etiology and that ¹²³I-metaiodobenzylguanidine (MIBG) might provide a precise method of detecting failure in chronic mechanical overload. Our aim was to develop a method for the dynamic analysis of ¹²³I-MIBG scintigrams which could yield a quantitative index of myocardial sympathetic neuronal function in this condition. We performed serial ¹²³I-MIBG scintigraphy in 33 volunteers, 10 orthotopic cardiac transplant recipients and 26 patients with chronic mechanical overload of the left ventricle. We constructed a compartmental model in which total heart activity represents the sum of cardiac sympathetic vesicular and cytosolic pools. Patients with antecedent mechanical overload heart failure or myocardial dysfunction had accelerated myocardial egress of tracer that we ascribed to a specific impairment in vesicular storage rather than to a more rapid turnover of an intact vesicular pool.

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