Abstract 12925: Combination of Cardiac I-123 Metaiodobenzylguanidine Imaging Findings and Early Repolarization Pattern Improve the Predictive Power of Sudden Cardiac Death in Patients With Chronic Heart Failure
Background: Identification of patients with chronic heart failure (CHF) at risk for sudden cardiac death (SCD) is an important objective. Cardiac I-123 metaiodobenzylguanidine (MIBG) imaging findings provide prognostic information in patients with CHF. On the other hand, early repolarization pattern (ERP) is associated with life-threatening arrhythmia events. Moreover, it has been shown that ERP would be associated with an increased risk of SCD in CHF patients. However, there is no information available on the long-term prognostic value of combining cardiac MIBG imaging findings and ERP for the prediction of SCD in CHF patients.
Methods: We studied 92 CHF outpatients (NYHA class: 2.1±0.6) with LVEF < 40% [30±7%) in our prospective cohort study. We performed MIBG scintigraphy, and measured the heart-to-mediastinum ratio on the delayed image (HMRd), of which the abnormal value was defined as < 1.7. Furthermore, we obtained the standard 12-lead electrocardiogram at enrollment. ERP was defined as J-point elevation ≤ 0.1 mV in at least 2 inferior or lateral leads.
Results: At enrollment, 41 patients had abnormal HMRd and 19 patients had ERP. During a follow-up period of 7.7±4.3 yrs, 22 patients died suddenly. A multivariate Cox analysis revealed that HMRd (p=0.001) and ERP (p=0.017) were significantly and independently associated with SCD. Kaplan-Meier analysis showed that SCD was significantly more frequently observed in patients with both abnormal HMRd and ERP and those with either abnormal HMRd or ERP than those with neither abnormal HMRd nor ERP (55% vs 33% vs 7%, respectively, p<0.0001). The hazard ratio for SCD prediction in patients with both abnormal HMRd and ERP was 14.7 (95%CI 3.6 to 60.1), which was twofold of the hazard ratio in patients with either abnormal HMRd or ERP (HR 6.5 [95%CI 1.8 to 7.8])
Conclusion: The combination of cardiac MIBG imaging and ERP would provide the incremental prognostic information for the prediction of SCD in CHF patients.
Author Disclosures: A. Kikuchi: None. T. Yamada: None. T. Morita: None. Y. Furukawa: None. S. Tamaki: None. Y. Iwasaki: None. M. Kawasaki: None. T. Kondo: None. T. Kawai: None. S. Takahashi: None. M. Ishimi: None. H. Hakui: None. T. Ozaki: None. Y. Sato: None. M. Seo: None. M. Fukunami: None.
- © 2014 by American Heart Association, Inc.