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Heart failure and cardiomyopathy
Prediction of sudden death in patients with mild-to-moderate chronic heart failure by using cardiac iodine-123 metaiodobenzylguanidine imaging
  1. Hidetaka Kioka1,
  2. Takahisa Yamada1,
  3. Takanao Mine1,
  4. Takashi Morita1,
  5. Yasumasa Tsukamoto1,
  6. Shunsuke Tamaki1,
  7. Masaharu Masuda1,
  8. Keiji Okuda1,
  9. Masatsugu Hori2,
  10. Masatake Fukunami1
  1. 1
    Division of Cardiology, Osaka General Medical Centre, Osaka, Japan
  2. 2
    Department of Cardiovasular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
  1. Dr H Kioka, Division of Cardiology, Osaka General Medical Centre, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan; hidetaka-k{at}umin.ac.jp

Abstract

Objective: To evaluate the usefulness of cardiac iodine-123 (123I) metaiodobenzylguanidine (MIBG) imaging as a predictor of sudden death in patients with chronic heart failure (CHF).

Design and setting: Prospective cohort study in a tertiary referral centre.

Patients: 97 outpatients with CHF with a radionuclide left ventricular ejection fraction <40% (mean (SD) 29% (7.5%)).

Interventions: At study entry, cardiac I-123 MIBG imaging was performed. The cardiac MIBG heart-to-mediastinum ratio (H/M) and washout rate (WR) were obtained from MIBG imaging.

Main outcome measures: Patients were assigned to two groups based upon 27% of WR, which was the mean (2SD) control WR. 48 of 97 patients with CHF had abnormal WR (⩾27%), whereas the remaining 49 patients had normal WR (<27%). All the study patients were then followed up.

Results: During the mean (SD) follow-up period of 65 (29) months, 12 (25%) patients in the abnormal WR group and 2 (4%) patients in the normal WR group died suddenly. Kaplan–Meier analysis revealed that sudden death was more often observed in patients with abnormal WR than those with normal WR (p = 0.001). On Cox regression analysis, MIBG WR, H/M on the delayed image and H/M on the early image were significantly associated with sudden death.

Conclusion: Cardiac MIBG imaging would be useful for predicting sudden death in patients with CHF.

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Footnotes

  • Competing interests: None declared.

  • Abbreviations:
    BNP
    brain natriuretic peptide
    CHF
    chronic heart failure
    H/M
    heart-to-mediastinum ratio
    I-123
    iodine-123
    LAD
    left atrial dimension
    LVEDD
    left ventricular end-diastolic dimension
    LVEF
    left ventricular ejection fraction
    MIBG
    metaiodobenzylguanidine
    NYHA
    New York Heart Association
    ROI
    region of interest
    VT
    ventricular tachycardia
    WR
    washout rate

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