Abstract 18464: Prognostic Value of Cardiac I-123 Metaiodobenzylguanidine Imaging in Patients With Chronic Heart Failure: A Prospective Comparative Study With Fragmented QRS Complexes
Backgrounds: Cardiac I-123 metaiodobenzylguanidine (MIBG) imaging provides prognostic information in patients with chronic heart failure (CHF). On the other hand, fragmented QRS complexes (fQRS) on the 12-lead ECG, which would be thought to reflect myocardial fibrosis, have been associated with poor outcome in CHF patients. However, there is no information available on the comparison of the prognostic values between MIBG imaging and fQRS in CHF patients.
Methods: We studied 111 CHF outpatients with LVEF <40% in our prospective cohort study. The cardiac MIBG heart-to-mediastinum ratio (H/M) and washout rate (WR) were calculated from the chest anterior view images obtained at 20 and 200 min after isotope injection. Abnormal WR was defined as > 27%. fQRS was defined by the presence of >2 notches on the R wave or the S wave and had to be present in >or=2 contiguous inferior (II, III, aVF), lateral (I, aVL, V(6)) or anterior (V(1) to V(5)) leads.
Results: During a follow up period of 7.8±4.4 yrs, 39 patients had cardiac death. At multivariate Cox analysis, WR (p=0.0002) and LVEF (p=0.0035) were significantly independently associated with cardiac death, while H/M at the delayed image (p=0.003) and fQRS (p=0.088) showed the association with cardiac death at univariate analysis. Patients with abnormal WR (>27%) had a significantly higher risk of cardiac death than those with normal WR (55% (31/56) vs 15% (8/55), p<0.0001, adjusted hazard ratio 4.1 (95%CI 1.8-9.7)), while there was a tendency of higher risk of cardiac death in patients with fQRS (63%(10/16) vs 31%(29/95), p=0.08, hazard ratio 1.9 (95%CI 0.9-3.9)).
Conclusion: The cardiac MIBG imaging had more valuable prognostic value than fQRS in CHF patients.
- © 2013 by American Heart Association, Inc.