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

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

Nuclear Medicine Communications: February 2017 - Volume 38 - Issue 2 - p 141–148
doi: 10.1097/MNM.0000000000000619

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 NET-inhibiting 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.

aDiagram Consulting, Kihei, Hawaii

bYardley, Pennsylvania

cDepartment of Radiology, Montefiore Medical Center, Division of Nuclear Medicine, Albert Einstein College of Medicine, Bronx, New York

dH2O Clinical LLC, Hunt Valley, Maryland, USA

Correspondence to Arnold F. Jacobson, MD, PhD, Diagram Consulting, 10 Lio Poele Place, Kihei, HI 96753, USA Tel: +1 808 214 5366; e-mail:

Received May 25, 2016

Accepted October 24, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.