Abstract 17371: Cardiac I-123 Metaiodobenzylguanidine Imaging Could Predict Pump Failure Death Irrespective of Chronic Kidney Disease but not Sudden Cardiac Death in Chronic Heart Failure Patients

Abstract

Background: Prediction of mode of death (sudden cardiac death (SCD) and pump failure death (PFD) in patients (pts) with chronic heart failure (CHF) may facilitate decisions about specific medications or devices. Cardiac I-123 Metaiodobenzylguanidine (MIBG) imaging provides prognostic information in CHF pts. However, renal dysfunction was observed as abnormal washout of cardiac MIBG imaging. We tried to prospectively evaluate the prognostic value of cardiac MIBG imaging in CHF pts, relating to renal dysfunction.

Method: We prospectively studied 109 consecutive CHF outpatients with radionuclide LVEF<40%. The cardiac MIBG washout rate (WR) was calculated from the chest anterior view images obtained at 20 and 200 min after isotope injection. Abnormal WR was defined as >27%. The primary endpoint was cardiac death (CD), including SCD and PFD.

Results: During follow up of 7.6±4.3 years, CD was observed in n 17 of 50 ( including SCD in 9 and PFD in 8 pts) of 50 pts with CKD (eGFR<60ml/min/1.73m²) and 20 of 59 without CKD (including SCD in15 and PFD in 5 pts). Kaplan-Meier analysis revealed that pts with abnormal WR had a significantly higher risk of PFD than those with normal WR in both CKD (26% vs 0%, p=0.0002, hazard ratio (HR):1.07, 95% CI 1.01 to 1.12) and non-CKD group (16% vs 3%, p=0.03, HR:1.06, 95% CI 1.001 to 1.12). However, there was no significant difference in the incidence of SCD between pts with and without abnormal WR in CKD group (23% vs 10%, p=0.13), while patients with abnormal WR had a significantly higher risk of SCD than with normal WR in non-CKD group (37% vs 19%, p=0.007,HR 4.0, 95% CI 1.3 to 11.7). At Cox analysis, abnormal WR was significantly associated with PFD in both CKD (p=0.013) and non-CKD (p=0.046), while abnormal WR was significantly associated with SCD only in non-CKD (p=0.011).

Conclusion: The cardiac MIBG imaging could predict PFD in CHF patients irrespective of CKD, while it could predict SCD only in patients without CKD but not with CKD