Prognostic usefulness of planar

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Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology


california; mission viejo; 3-Iodobenzylguanidine; Aged; Female; Follow-Up Studies; Heart; Heart Failure; Humans; Iodine Radioisotopes; Male; Middle Aged; Predictive Value of Tests; Prognosis; Radiopharmaceuticals; Stroke Volume; Survival Analysis; Sympathetic Nervous System; Time Factors; Tomography, Emission-Computed, Single-Photon


Background: To evaluate whether planar 123I-MIBG myocardial scintigraphy predicts risk of death in heart failure (HF) patients up to 5 years after imaging.

Methods and results: Subjects from ADMIRE-HF were followed for approximately 5 years after imaging (964 subjects, median follow-up 62.7 months). Subjects were stratified according to the heart/mediastinum (H/M) ratio (< 1.60 vs ≥ 1.60) on planar 123I-MIBG scintigraphic images obtained at baseline in ADMIRE-HF. Cox proportional hazards models and Kaplan-Meier analyses were used to evaluate time to death, cardiac death, or arrhythmic events for subjects stratified by H/M ratio, baseline left ventricular ejection fraction (LVEF: < 25% and 25 to ≤ 35%), and by H/M strata within LVEF strata. All-cause mortality was 38.4% vs 20.9% and cardiac mortality was 16.8% vs 4.5%, in subjects with H/M < 1.60 vs ≥ 1.60, respectively (P < 0.05 for both comparisons). Subjects with preserved sympathetic innervation of the myocardium (H/M ≥ 1.60) were at significantly lower risk of all-cause and cardiac death, arrhythmic events, sudden cardiac death, or potentially life-threatening arrhythmias. Within LVEF strata, a trend toward a higher mortality for subjects with H/M < 1.60 was observed reaching significance for LVEF 25 to ≤ 35% only.

Conclusions: During a median follow-up of 62.7 months, patients with H/M ≥ 1.60 were at significantly lower risk of death and arrhythmic events independently of LVEF values.

Keywords: 123I-MIBG; cardiac death; congestive heart failure; prognosis.

Clinical Institute

Cardiovascular (Heart)