Incremental prognostic value of cardiac metaiodobenzylguanidine imaging over the co‐morbid burden in acute decompensated heart failure

Abstract

Aims Co-morbidities are associated with poor clinical outcomes in patients with chronic heart failure, while cardiac iodine-123 (I-123) metaiodobenzylguanidine (MIBG) imaging provides prognostic information in such patients. We sought to prospectively investigate the incremental prognostic value of cardiac MIBG imaging over the co-morbid burden, in patients admitted for acute decompensated heart failure (ADHF). Methods and results In 433 consecutive ADHF patients with survival to discharge, we measured the co-morbidity using age-adjusted Charlson co-morbidity index (ACCI), commonly employed to evaluate a weighted and scored co-morbid condition, adding additional points for age. In cardiac MIBG imaging, the cardiac MIBG heart-to-mediastinum ratio (late HMR) was measured on the delayed image. Over a follow-up period of 2.9 ± 1.5 years, 160 patients had a cardiac event (a composite of cardiac death and unplanned hospitalization for worsening heart failure). Patients with high ACCI (≥6: median value) had a significantly greater risk of a cardiac event. In multivariate Cox analysis, the ACCI and late HMR were significantly and independently associated with a cardiac event. In both high and low ACCI subgroups (ACCI ≥ 6 and <6, respectively), patients with low late HMR had a significantly greater risk of a cardiac event (high ACCI: 51% vs. 34% P = 0.0026, adjusted HR 1.74 [1.21-2.51]; low ACCI: 34% vs. 17%, P = 0.0228, adjusted HR 2.19 [1.10-4.37]). Conclusions Cardiac MIBG imaging could provide additional prognostic information over ACCI, which was also promoted to be a useful risk model, in patients admitted for ADHF.

Exploring disease interrelationships in older inpatients: a single-centre, retrospective study

“…We used the ACCI, which is a reliable tool for predicting morbidity (29). Senior older inpatients and older individuals with longevity had high ACCI values, which is consistent with previous reports (30,31). As shown in Table 1, both men and women had a high ACCI, which could be attributed to the fact that they were all older inpatients.…”

123I-MIBG imaging in heart failure: impact of comorbidities on cardiac sympathetic innervation

“…A recent study of Bencivenga et al documented that the number of concomitant pathologies does not influence 123 I-MIBG parameters of cardiac innervation, including late H/M ratio, as it is evident from the results of the regression analysis, which also included age, gender, BMI, and LVEF as independent variables [63]. However, a further study by Kayama et al has shown that cardiac 123 I-MIBG imaging could provide additional prognostic information over the comorbid burden, in patients with acute decompensated HF [64].…”