Abstract 14572: Cardiac I-123 Metaiodobenzylguanidine Imaging Could Identify Patients With Chronic Heart Failure and LVEF<35% at Low Risk for Cardiac Death, Irrespective of Mode of Death
Background: Prediction of mode of death (sudden cardiac death (SCD) and pump failure death (PFD)) in patients with chronic heart failure (CHF) may facilitate decisions about specific medications or devices. Cardiac I-123 metaiodobenzylguanidine(MIBG) imaging provides prognostic information in patients with CHF. However, the risk stratification of CHF patients by MIBG imaging remains not to be fully evaluated, relating to mode of death.
Methods: At the enrollment, we performed cardiac MIBG imaging in 81 CHF patients with LVEF<35% (26±6%). The cardiac MIBG heart-to-mediastinum ratio (H/M) and washout rate (WR) was calculated from the chest anterior view images obtained at 20 and 200 min after isotope injection. We ivided H/M and WR into 6 grades, scored as 0 to 5, according to the deviation degree of normal control values H/M:2.65±0.32, WR:9.6±8.5%), respectively, and these patients were classified into 3 groups according to the MIBG score defined as the sum of WR and H/M scores; low (1-4), intermediate (5-7) and high (8-10) score groups,
Results: These patients were completely followed up for at least 5 years after cardiac MIBG imaging. During the follow-up period (6.9±3.1yrs), 16 and 11 of 81 patients had SCD and PFD, respectively. At multivariate Cox analysis, only MIBG score was significantly associated with SCD (p=0.001) and PFD (p=0.002), although H/M and WR showed the association with the poor outcomes, at univariate analysis. Patients with lower MIBG score had significantly lower risk of SCD (low (n=19); 0%, intermediate (n=37); 19%, high (n=25); 36%, p=0.001) and PFD ((low; 0%, intermediate; 11%, high; 28%, p=0.002). Positive predictive value of low MIBG score for the identification of patients without SCD or PFD was 100%.
Conclusion: The cardiac MIBG imaging could identify CHF patients with LVEF<35% at low risk for cardiac death, irrespective of mode of death.
- © 2013 by American Heart Association, Inc.