Assessment of anthracycline-related myocardial adrenergic derangement by [ 123i]metaiodobenzylguanidine scintigraphy

• Published in: European journal of cancer (1990) Vol. 31; no. 1; pp. 26 - 31
• Main Authors: Olmos, R.A.Valdés, Bokkel Huinink, W.W.ten, Hoeve, R.F.A.ten, van Tinteren, H., Bruning, P.F., van Vlies, B., Hoefnagel, C.A.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 1995
• Subjects: 3-Iodobenzylguanidine; [ 123I]MIBG; Adrenergic Fibers - diagnostic imaging; Adrenergic Fibers - drug effects; Adult; anthracycline therapy; Doxorubicin - adverse effects; Epirubicin - adverse effects; Female; Heart - diagnostic imaging; Heart - innervation; Humans; Iodine Radioisotopes; Iodobenzenes - metabolism; Male; Middle Aged; myocardial adrenergic derangement; Myocardium - metabolism; Neoplasms - drug therapy; Radionuclide Imaging; Stroke Volume; [ 123I]MIBG; myocardial adrenergic derangement; anthracycline therapy
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/0959-8049(94)00357-B

Myocardial adrenergic neuron integrity and function were evaluated in 21 patients who had received doxorubicin or epirubicin for various malignancies. Myocardial uptake of iodine-123 metaiodobenzylguanidine ([ 123I]MIBG), a marker suitable for the study of myocardial neuron injury, was calculated from planar scintigraphic images after 4 h and the washout between 15 min and 4 h. In 13 patients with normal left ventricle ejection fraction (LVEF) analysed at three cumulative dose levels (no, low and middle dose), [ 123I]MIBG uptake tended to be significantly impaired ( z =−2.772, P = 0.0056), at higher cumulative dose levels, before significant LVEF changes were observed. [ 123I]MIBG values were considerably decreased in 2 7 patients investigated at low cumulative dose and in 3 8 cases at the middle dose level. On follow-up, 1 of these patients, who had normal LVEF after completion of chemotherapy but whose [ 123I]MIBG values had progressively deteriorated during anthracycline therapy, subsequently developed congestive heart failure; another patient, whose [ 123I]MIBG values were impaired at the middle dose level, developed persistent reduced LVEF 5 months after completing therapy. In 8 patients, who had developed persistently, reduced LVEF at high doxorubicin cumulative dose levels, [ 123I]MIBG, performed in the period after chemotherapy discontinuation, was invariably abnormal. These data suggest that myocardial adrenergic derangement plays a role in anthracycline-associated cardiotoxicity: its appearance, even at low cumulative anthracycline dose levels, may reflect impairment of the intravesicular norepinephrine storage by incipient anthracycline-associated cardiac neuron injury. [ 123I]MIBG scintigraphy may be useful to assess myocardial adrenergic derangement during and in the follow-up of anthracycline therapy and potentially detect patients who are at risk.