Abstract 14051: Prognostic Value of Cardiac Iodine-123 Metaiodobenzylguanidine Imaging in Patients With Reduced and Preserved Left Ventricular Ejection Fraction Admitted for Acute Decompensated Heart Failure
Background: Cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging has been shown to provide prognostic information in patients with heart failure. However, little is known about the difference in prognostic value of sympathetic nerve activity between the patients with heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF) admitted for acute decompensated heart failure (ADHF).
Methods: We studied 153 consecutive patients admitted for ADHF and discharged with survival (age: 74±13 yrs, male: 56%, NYHA class at discharge: 2.0±0.8, left ventricular ejection fraction [LVEF]: 46±15%). Cardiac MIBG imaging, echocardiography and venous blood sampling were performed just before discharge. The cardiac MIBG heart-to-mediastinum ratio (HMR) and washout rate (WR) were calculated from the chest anterior view images obtained at 20 and 200min after isotope injection. The endpoint was unplanned hospitalization for worsening heart failure (WHF).
Results: There were 77 patients with HFrEF (LVEF<45%) and 76 patients with HFpEF (LVEF≧45%). HMR on early and delayed images (late HMR) in HFrEF patients were significantly lower than those in HFpEF patients (1.78±0.27 vs. 1.90±0.29, p=0.0127, and 1.58±0.26 vs. 1.73±0.27, p=0.0007, respectively). WR was significantly higher in patients with HFrEF than HFpEF (38.3±14.2% vs. 31.2±15.5%, p=0.0035). During a follow-up period of 1.6±0.9 years, 48 patients had WHF. At multivariate Cox analysis, late HMR was significantly associated with WHF in both HFrEF (p=0.0161) and HFpEF (p=0.0010) patients. Receiver-operator curve analysis revealed that late HMR of 1.44 and 1.67 were fair discriminators for WHF in HFrEF (AUC 0.707 [95% CI 0.592-0.805], p=0.0032; sensitivity 56% and specificity 80%) and HFpEF patients (AUC 0.708 [95% CI 0.592-0.806], p=0.0022; sensitivity 70% and specificity 74%), respectively. Kaplan-Meier analysis showed that the patients with late HMR <1.44 and <1.67 had a significantly higher risk of WHF in HFrEF (p=0.0023) and HFpEF patients (p=0.0001), respectively.
Conclusions: Cardiac sympathetic nerve overactivity was associated with poor outcome both in HFrEF and HFpEF patients, although cardiac sympathetic nerve activity was higher in HFrEF patients than in HFpEF 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. Ozaki: None. Y. Sato: None. M. Seo: None. I. Ikeda: None. E. Fukuhara: None. M. Abe: None. J. Nakamura: None. M. Fukunami: None.
- © 2016 by American Heart Association, Inc.