Risk stratification of patients with chronic heart failure using cardiac iodine‐123 metaiodobenzylguanidine imaging: incremental prognostic value over right ventricular ejection fraction

Abstract

AimsRight ventricular (RV) systolic dysfunction has been shown to be an independent predictor of clinical outcome in patients with chronic heart failure (CHF), and cardiac metaiodobenzylguanidine (MIBG) imaging also provides prognostic information. We aimed to evaluate the long‐term predictive value of combining RV systolic dysfunction and abnormal findings of cardiac MIBG imaging on outcome in CHF patients.Methods and resultsWe enrolled 63 CHF outpatients with left ventricular ejection fraction (EF) <40% in a prospective cohort study. At entry, RVEF was measured by radionuclide angiography. Furthermore, cardiac MIBG imaging was performed, and the cardiac MIBG washout rate (WR) was calculated. Reduced RVEF was defined as ≤37%, and abnormal WR was defined as >27%. The study endpoint was unplanned hospitalization for worsening heart failure (WHF) and cardiac death. During a follow‐up period of 8.9 ± 4.3 years, 19 of 63 patients had unplanned hospitalization for WHF, and 19 of 63 patients had cardiac death. In multivariate analysis, both WR and RVEF were independent predictors of unplanned WHF hospitalization, while WR was also an independent predictor of cardiac death. A risk‐stratification model based on independent predictors of unplanned WHF hospitalization separated the patients into those with low (absence of the predictors), intermediate (one of the predictors), and high (two or more of the predictors) risk of unplanned WHF hospitalization (P < 0.0001) or cardiac death (P = 0.0113).ConclusionsCardiac MIBG imaging provides incremental value when it is used along with RV systolic dysfunction to predict clinical outcome in patients with CHF.

ESC Heart Failure: a new journal aims to broaden heart failure views

“…The biological variation was less pronounced when inert gas rebreathing techniques were used. In addition to the available prognostic biomarker studies, prognostic assessments were recently performed in patients with HF using cardiac [ 123 I]metaiodobenzylguanidine imaging and late gadolinium enhancement . Kataoka investigated the clinical significance of bilateral leg oedema and the added value of monitoring weight gain using data from 1826 outpatient visits of 83 patients with mild to moderate HF.…”

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

“…13 Cardiac iodine-123 (I-123) metaiodobenzylguanidine (MIBG) imaging is known to estimate cardiac adrenergic nerve activity and provides prognostic information on patients with chronic HF. [14][15][16][17][18][19][20] Moreover, we have recently reported the prognostic value of cardiac MIBG imaging in patients admitted for ADHF. 21 The aim of this study was to evaluate the incremental prognostic value of cardiac MIBG imaging over the co-morbid burden in case of usefulness of ACCI in patients admitted for ADHF.…”

“…In HF, abnormalities in cardiac autonomic control characterized by sympathetic overactivity are strongly associated with poor clinical outcomes 13 . Cardiac iodine‐123 (I‐123) metaiodobenzylguanidine (MIBG) imaging is known to estimate cardiac adrenergic nerve activity and provides prognostic information on patients with chronic HF 14–20 . Moreover, we have recently reported the prognostic value of cardiac MIBG imaging in patients admitted for ADHF 21 …”