DESCRIPTION
In individuals with heart failure, activation of the sympathetic nervous system is an early response to compensate for decreased myocardial function. Overactive sympathetic innervation associated with heart failure involves increased neuronal release of norepinephrine, the main neurotransmitter of the cardiac sympathetic nervous system. The scintigraphic imaging agent iodine 123 meta-iodobenzylguanidine (MIBG) is proposed as a prognostic marker in individuals with heart failure to aid in the identification of individuals at risk of one- and two-year mortality. Once the agent is administered, planar images of the thorax are acquired at fifteen minutes and then at four hours, measuring the heart to mediastinum (H/M) ratio. The marker is also proposed as a guide for treatment decisions or to monitor the effectiveness of heart failure treatments. Currently, AdreView™ is the only FDA approved imaging agent available for this purpose.
POLICY
Myocardial sympathetic innervation imaging with iodine 123 meta-iodobenzylguanidine (i.e., I-MIBG, MIBG) for individuals with heart failure is considered investigational.
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ADDITIONAL INFORMATION
There is a lack of evidence to support the use of MIBG imaging in the management of individuals with heart failure.
SOURCES
American College of Cardiology. American Heart Association. Heart Failure Society of America. (2022). 2022 AHA/ ACC/HFSA guideline for the management of heart failure: executive summary: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Retrieved September 20, 2022 from www.acc.org.
BlueCross BlueShield Association. Evidence Positioning System. (10:2023). Myocardial sympathetic innervation imaging in patients with heart failure (6.01.56). Retrieved October 5, 2023 from https://www.evidencepositioningsystem.com/. (26 articles and/or guidelines reviewed)
Nakata, T., Kakajima, K., Yamashina, S., Yamada, T., Momose, M., Kasama, S., et al. (2013). A pooled analysis of multicenter cohort studies of 123I-mIBG imaging of sympathetic innervation of assessment of long-term prognosis in heart failure. Journal of the American College of Cardiology: Cardiovascular Imaging, 6 (7), 772-784. (Level 2 evidence)
Narula, J., Gerson, M., Thomas, G.S., Cerqueira, M.D., & Jacobson, A.F. (2015). I-MIBG imaging for prediction of mortality and potentially fatal events in heart failure: the ADMIRE-HFX study. The Journal of Nuclear Medicine, 56 (7), 1011-1018. (Level 2 evidence)
National Heart, Lung, and Blood Institute. (2011). Report of the National Heart, Lung, and Blood Institute working group on the translation of cardiovascular molecular imaging. Circulation, 123 (19), 2157-2163.
Shah, A. M., Bourgoun, M., Narula, J., Jacobson, A. F., & Solomon, S. D. (2012). Influence of ejection fraction on the prognostic value of sympathetic innervation imaging with iodine-123 MIBG in heart failure. JACC: Cardiovascular Imaging, 5 (11), 1139-1146. (Level 2 evidence)
Treglia, G., Stefanelli, A., Bruno, I., & Giordano, A. (2013). Clinical usefulness of myocardial innervations imaging using iodine-123-meta-iodobenzylguanidine scintigraphy in evaluating the effectiveness of pharmacological treatments in patients with heart failure: An overview. European Review for Medical and Pharmacological Sciences, 17 (1), 56-68. (Level 2 evidence)
Verschure, D., Veltman, C., Manrique, A., Somsen, A., Koutelou, M., Katsikis, A., et al. (2014). For what endpoint does myocardial 123I-MIBG scintigraphy have the greatest prognostic value in patients with chronic heart failure? Results of a pooled individual patient data meta-analysis. European Heart Journal - Cardiovascular Imaging, 15, 996-1003 (Level 2 evidence)
ORIGINAL EFFECTIVE DATE: 12/14/2013
MOST RECENT REVIEW DATE: 11/9/2023
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