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Prediction of Sudden Death by Using Cardiac Iodine-123 Metaiodobenzylguanidine Imaging in Patients With Mild to Moderate Chronic Heart Failure.
  1. Hidetaka Kioka (hidetaka-k{at}umin.ac.jp)
  1. Division of Cardiology, Osaka General Medical Centre, Japan
    1. Takahisa Yamada
    1. Division of Cardiology, Osaka General Medical Centre, Japan
      1. Takanao Mine
      1. Division of Cardiology, Osaka General Medical Centre, Japan
        1. Takashi Morita
        1. Division of Cardiology, Osaka General Medical Centre, Japan
          1. Yasumasa Tsukamoto
          1. Division of Cardiology, Osaka General Medical Centre, Japan
            1. Shunsuke Tamaki
            1. Division of Cardiology, Osaka General Medical Centre, Japan
              1. Masaharu Masuda
              1. Division of Cardiology, Osaka General Medical Centre, Japan
                1. Keiji Okuda
                1. Division of Cardiology, Osaka General Medical Centre, Japan
                  1. Masatsugu Hori
                  1. Division of Cardiology, Osaka General Medical Centre, Japan
                    1. Masatake Fukunami
                    1. Division of Cardiology, Osaka General Medical Centre, Japan

                      Abstract

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

                      Design Prospective cohort study.

                      Setting Tertiary referral centre.

                      Patients Ninety-seven CHF outpatients with a radionuclide left ventricular ejection fraction < 40% ( 29±7.5% ).

                      Intervensions At the 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 We divided patients into two groups based upon 27% of WR, which was the mean control WR +2 SD. Forty-eight of 97 CHF patients had abnormal WR (≥27%), while the remaining 49 patients had normal WR (<27%). All the study patients were then followed up.

                      Results During the mean follow up period of 65±29 months, 12 patients (25%) died suddenly in abnormal WR group, while two patients (4%) died in normal WR group. Kaplan-Meier analysis revealed that sudden death was more frequently observed in patients with than without abnormal WR (p=0.0010). At 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 to predict sudden death in patients with CHF.

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