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Interobserver variability in I-123 MIBG sympathetic imaging in advanced heart failure patients
Session:
Posters 5 - Écran 02 - Imagiologia Cardíaca
Speaker:
Ines Rodrigues
Congress:
CPC 2018
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.4 Nuclear Imaging
Session Type:
Posters
FP Number:
---
Authors:
Dra. Inês Rodrigues; Ana Abreu; Luís Oliveira; António Martins; Mário Martins Oliveira; Pedro Silva Cunha; Helena Santa Clara; Miguel Mota Carmo; Luís Almeida Morais; Pedro M Daniel; Rita Ilhão Moreira; Rui Cruz Ferreira
Abstract
<p><strong>Background</strong>: Cardiac sympathetic imaging with I-123 meta-iodobenzylguadine (MIBG) is an important tool for detecting alterations in the myocardial adrenergic nervous system and also an important predictor of mortality. Inter-observer variability is not completely established in advanced heart failure (HF) patients (pts).</p> <p><strong>Purpose</strong>: The purpose of this study was to assess interobserver variability of I-123 MIBG scintigraphy in HF pts.</p> <p><strong>Methods</strong>: 123I-MIBG scintigraphy was performed in advanced HF pts (LVEF≤35%). The protocol included manual tracing of the region of interest over the heart and the upper mediastinum and sequential planar images acquisitions 15 minutes and 4 hours after I-123I MIBG injection. All studies were separately analyzed by two independent and trained observers. I-123 MIBG uptake and clearance were determined by calculating early heart/mediastinum ratio (HMR), late HMR and myocardial washout rate (WOR). Inter-observer variability of early HMR, late HMR and WOR was assessed using intra-class correlation coefficients (ICCs; ICC<0.20-poor agreement; 0.21-0.40-fair agreement; 0.41-0.60-moderate agreement; 0.61-0.80-good agreement; 0.81-1.00-very good agreement). Also, using the cut-off value described in literature for prediction of poor prognosis in heart failure patients with late HMR (late HMR ≤1.5 and ≤1.6) and with WOR (≥27), agreement in achieving this cut-off values was assessed using Cohen´s κ coefficient [ranging from -1 (perfect disagreement) to +1 (perfect agreement; κ values≥0.75-strong agreement; 0.4>κ<0.75-moderate agreement, and κ≤ 0.4-poor agreement).</p> <p><strong>Results</strong>: 177 HF patients underwent I-123 MIBG scintigraphy (69% men, mean age 69±11 years, NYHA functional class 2.8±0.5, LVEF 26±7%). Interobserver ICCs of early and late HMR were good (ICC 0.728; 95% CI 0.684-0.823; and 0.680; 95% CI 0.475-0.793, respectively), but fair to WOR (ICC 0.325; 95% CI 0.100-0.465). There was a moderate agreement in defining patients as having poor prognosis using cut-off values of late HMR≤1.5 (k=0.503), but poor agreement for late HMR≤1.6 (K=0.383) and for WO≥27 (k=0.167).</p> <p><strong>Conclusions</strong>: The most reproducible parameter for evaluating alteration in the myocardial adrenergic nervous system was the HMR≤1.5, which may favor the use of this parameter, comparing to others, in the evaluation of HF patients. Improved standardization of cardiac MIBG imaging protocols are necessary to increase clinical applicability of this imaging modality.</p>
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