Abstract 13910: Incremental Prognostic Value of Cardiac Iodine-123 Metaiodobenzylguanidine Imaging in Patients With Chronic Heart Failure: A Comparison With Right Ventricular Ejection Fraction
Background: Right ventricular (RV) systolic dysfunction has been shown to be an independent predictor of the clinical outcome in patients with chronic heart failure (CHF). In addition, cardiac iodine-123 (I-123) metaiodobenzylguanidine (MIBG) imaging also provides prognostic information in patients with CHF. However, the long-term predictive value of combining RV systolic dysfunction and cardiac MIBG imaging in CHF patients has not been evaluated. We sought to investigate whether cardiac I-123 MIBG imaging provides additional prognostic information to RV systolic dysfunction in CHF patients.
Methods: We studied 63 CHF outpatients (NYHA class: 2.1±0.6, ischemic origin: 52%) whose radionuclide left ventricular ejection fraction (EF) was less than 40% (30.0±7.3%). At the entry, RVEF was measured by radionuclide angiography. Furthermore, cardiac I-123 MIBG imaging was performed, and the cardiac MIBG washout rate (WR) was calculated from the chest anterior view images obtained at 20 and 200min after isotope injection. Reduced RVEF was defined as ≦37% as reported previously. Abnormal WR was defined as more than 27% (the mean control WR +2SD). The study endpoint was unplanned hospitalization for worsening heart failure.
Results: During a follow-up period of 7.5±4.9 years, 19 of 63 patients reached the endpoint. At multivariate Cox analysis, out of the variables including clinical, echocardiographic, hemodynamic, biochemical, MIBG parameters and RVEF, WR (p=0.0110), RVEF (p=0.0204), and NYHA class (p=0.0495) were significantly independently associated with the endpoint. Kaplan-Meier analysis showed that the patients with abnormal WR had a significantly higher risk of reaching the endpoint than those with normal WR both in the patients with reduced RVEF and in the patients without reduced RVEF (Figure).
Conclusion: Cardiac I-123 MIBG imaging would provide incremental value to RV systolic dysfunction in the prediction of clinical outcome in CHF patients.
Author Disclosures: S. Tamaki: None. T. Yamada: None. T. Morita: None. Y. Furukawa: None. Y. Iwasaki: None. M. Kawasaki: None. A. Kikuchi: 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.