Many studies have shown that a one-time 123 I-metaiodobenzylguanidine ( 123 I-MIBG) scintigraphic study during a stable period is useful for determining the prognosis of patients with chronic heart failure (CHF). However, the findings from this imaging modality are well known to be improved by medical treatment for heart failure. Accordingly, this study was performed to determine whether serial 123 I-MIBG scintigraphic studies represent a reliable prognostic marker for patients with CHF. Methods: A total of 208 patients with CHF (left ventricular ejection fraction [LVEF] , 45%) and with no cardiac events for at least 5 mo were identified on the basis of a history of decompensated acute heart failure requiring hospitalization. The delayed percentage of denervation (% denervation), delayed heart-to-mediastinum count (H/M) ratio, and washout rate (WR) were determined from the patients' 123 I-MIBG images just before they left the hospital and after they had received 6 mo of treatment. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and LVEF were also determined by echocardiography at the same time points. Results: Of the 208 patients, 56 experienced fatal cardiac events during the study. The mean follow-up period was 4.45 6 1.82 y. The baseline H/M ratio and WR; follow-up % denervation, H/M ratio, and WR; D-% denervation, H/M ratio, and WR; baseline LVEF; follow-up LVEDV, LVESV, and LVEF; and D-LVEDV, D-LVESV, and D-LVEF were significantly worse in the cardiac death group. A Cox regression analysis showed that the D-WR was an independent predictor of cardiac death. Moreover, sudden death occurred in 13 of the 56 patients with cardiac death. A Cox regression analysis also showed that the D-WR was an incremental predictor of sudden death. The cardiac death-free rate and sudden death-free rate were significantly higher in patients with D-WR less than 25% and D-WR less than 22% than in patients with D-WR greater than or equal to 25% and D-WR greater than or equal to 22%. Conclusion: D-WR obtained from serial 123 I-MIBG scintigraphic studies can be useful for predicting cardiac death and sudden death in stabilized patients with CHF.

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Visceral adipose tissue-derived serine protease inhibitor (vaspin) is an interesting novel adipocytokine with insulin-sensitizing effects. Some studies have suggested that vaspin could play an important role in the development of obesity and metabolic disorders. The induction of vaspin mRNA expression could represent a compensatory mechanism associated with obesity, severe insulin resistance and type 2 diabetes mellitus, however it is unclear whether a correlation exists between human vaspin serum levels and markers of insulin sensitivity and glucose or lipid metabolism. Vaspin serum concentrations have been shown to be lower in lean subjects and competitive sportsmen with long-term physical training, but they are increased with weight loss associated with a physical training programme. In conclusion, there is at present no clear proof of a causal link between vaspin and visceral fat accumulation, or insulin resistance. This article reviews the role of vaspin in obesity-associated diseases and its potential as a new biomarker for obesity and impaired insulin sensitivity.

Objective