MIBG Scintigraphy as a Tool for Selecting Patients Requiring Implantable Cardioverter Defibrillator (ICD)

Not Applicable

• Conditions: Sudden Death; Heart Failure
• Interventions: Radiation: MIBG for diagnostic purpose

• Registration Number: NCT01185756
• Lead Sponsor: Assistance Publique - Hôpitaux de Paris

Brief Summary

The aim of the study is to assess the cardiac innervation in patients with heart failure to better select candidates for an implantable cardioverter defibrillator. Cardiac innervation will be assessed using an imaging agent administered intravenously.

Detailed Description

The survival benefit provided by implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death in heart failure compared to medical treatment alone is well established. First limited to the most severe patients, the indications have gradually been extended in accordance with the results of more recent studies. This beneficial effect in terms of public health is accompanied by an increase in health spending which threatens to grow strongly at short and medium term. However, the majority of ICDs implanted will not be solicited because of the overall low incidence of severe ventricular arrhythmias in the population meeting the implantation criteria. To optimize our resources, it is therefore important to better assess the risk of sudden death in those patients candidates for ICD implantation.

The overactivation of NEURO-humoral systems plays an important role in the progression of heart failure, and in the occurrence of ventricular arrhythmias. The iodine-123 meta-iodobenzylguanidine scintigraphy (MIBG), is a functional imaging method that can noninvasively evaluate cardiac sympathetic innervation. It has been shown that cardiac adrenergic hyperactivation estimated by MIBG scintigraphy was associated with a poor outcome, and that its value was independent and superior to other prognostic factors in heart failure. More importantly, the risk of occurrence of major cardiac events is minimal when the cardiac uptake of MIBG is high. Furthermore, plasma natriuretic peptides (particularly BNP and NT-proBNP), which are other indicators of the NEURO-hormonal activation used in the diagnosis and assessment of prognosis in heart failure, are predictive of the risk of occurrence of sudden death in the same population. In summary, the MIBG scintigraphy and NT-proBNP are two prognostic markers in heart failure related to the degree of NEURO-hormonal dysfunction, and have a good negative predictive value of mortality. Their combined use could therefore help identify patients at low risk of severe arrhythmias.These tests are not currently part of heart failure diagnosis in patients who are candidates for ICD implantation.

Study Timeline

• Study First Submitted: 2010-07-09
• Study First Submitted QC: 2010-08-19
• Study First Posted: 2010-08-20
• Study Start: 2010-09
• Primary Completion: 2017-03
• Status Verified: 2017-12
• Study Completion: 2018-01
• Last Update Submitted: 2018-01-10
• Last Update Posted: 2018-01-11

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 330

Inclusion Criteria

• Indication for ICD in primary prevention according to European Society of Cardiology guidelines

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Exclusion Criteria

• Secondary prevention indication of ICD
• Acute coronary syndrome within the last 40 days
• Revascularization procedure (bypass or percutaneous coronary angioplasty) performed within the last 3 months of planned
• Pregnancy or lactating female

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
ICD implantation	MIBG for diagnostic purpose	MIBG for diagnostic purpose: MIBG scintigraphy for diagnostic purpose

Primary Outcome Measures

Name	Time	Method
Assessment of the cardiac MIBG uptake ratio for identification of patients at very low risk of severe ventricular arrhythmias.	1-3 months	Description appropriate therapy delivered by the ICD, or sustained ventricular tachycardia.

Secondary Outcome Measures

Name	Time	Method
Sudden cardiac death	1-3 months
Overall mortality	every 6 months during 2 years
sudden cardiac death	every 6 months during 3 years
Assessment of the cardiac MIBG uptake ratio for identification of patients at very low risk of severe ventricular arrhythmias.	every 6 months during 3 years	description appropriate therapy delivered by the ICD or sustained ventricular tachycardia

Trial Locations

Locations (1)

Groupe Hospitalier Bichat - Claude Bernard; 🇫🇷 Paris, Ile De France, France