Abstract 3027: Cardiac Sympathetic Denervation and Ongoing Myocardial Damage for Prognosis in Heart Failure
BACKGROUND: Activation of sympathetic nervous system plays an important role in the progression of heart failure. Iodine-123-metaiodobenzylguanidine (123I-MIBG), an analogue of norepinephrine, can assess cardiac sympathetic nervous function. On the other hand, heart-type fatty acid binding protein (H-FABP), a novel marker of ongoing myocardial damage, is released into the circulation when the myocardium is injured. The prognostic value of combination 123I-MIBG imaging and H-FABP in heart failure is unknown
METHODS AND RESULTS: We prospectively enrolled consecutive 104 patients with heart failure in whom we quantified 123I-MIBG scintigraphy, simultaneously measured serum H-FABP and plasma brain natriuretic peptide levels, and analyzed outcome. The Cox multivariate proportional hazard analysis revealed that augmented H-FABP level and decreased heart to mediastinum ratio of 123I-MIBG at 240 min (delayed H/M ratio) were the independent predictors for cardiac events. The cut-off values for H-FABP and delayed H/M ratio were determined from the receiver operating characteristic curves as 5.2 ng/ml for H-FABP and 1.73 for delayed H/M ratio. The cardiac event rate was markedly higher in patients with both H-FABP and delayed H/M ratio of 123I-MIBG were abnormal. Interestingly, no cardiac events occurred in patients with both H-FABP level and delayed H/M ratio were normal.
CONCLUSIONS: H-FABP may add prognostic information to delayed H/M ratio of 123I-MIBG imaging, and the combination of these approaches may improve the accuracy of prognostic determination in heart failure.