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Prognostic value of cardiac sympathetic nerve activity evaluated by [123I]m-iodobenzylguanidine imaging in patients with ST-segment elevation myocardial infarction
  1. Shu Kasama1,2,
  2. Takuji Toyama1,
  3. Hiroyuki Sumino2,
  4. Hisao Kumakura2,
  5. Yoshiaki Takayama2,
  6. Kazutomo Minami2,
  7. Shuichi Ichikawa2,
  8. Naoya Matsumoto3,
  9. Yuichi Sato4,
  10. Masahiko Kurabayashi1
  1. 1Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, Gunma, Japan
  2. 2Department of Cardiology, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Gunma, Japan
  3. 3Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
  4. 4Department of Imaging, Health Park Clinic, Takasaki, Gunma, Japan
  1. Correspondence to Dr Shu Kasama, Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma 371-0034, Japan; s-kasama{at}bay.wind.ne.jp

Abstract

Background Many studies have shown that cardiac sympathetic nerve activity evaluated by [123I]m-iodobenzylguanidine ([123I]MIBG) scintigraphic study during a stable period is useful for determining the prognosis of patients with chronic heart failure.

Objective To examine whether results of this imaging method performed 3 weeks after the onset of ST-segment elevation myocardial infarction (STEMI) are a reliable prognostic marker for patients with STEMI.

Methods The study analysed findings for 213 consecutive patients with STEMI undergoing [123I]MIBG scintigraphy. The left ventricular (LV) end-diastolic and end-systolic volume and LV ejection fraction (EF) were determined by left ventriculography or echocardiography 3 weeks after the onset of STEMI. The delayed total defect score, heart-to-mediastinum ratio and washout rate (WR) were also determined from [123I]MIBG scintigraphy at the same time.

Results Of the 213 patients, 46 experienced major adverse cardiac events (MACE) during the study. The median follow-up period was 982 days. Patients were divided into an event-free group (n=167; 78.4%) and a MACE group (n=46; 21.6%). The LV and [123I]MIBG scintigraphic parameters in the event-free group were better than those in the MACE group. Multivariate Cox regression analyses revealed that WR was a significant predictor of MACE along with oral nicorandil (ATP-sensitive potassium channel opener) treatment and undergoing percutaneous coronary intervention. On Kaplan–Meier analysis, the event-free rate of patients with a WR<40% was significantly higher than that in patients with a WR≥40% (p<0.001). Even when confined to patients with LVEF>45%, WR was a predictor of MACE, pump failure death, cardiac death and progression of heart failure in patients with STEMI.

Conclusion WR evaluated by [123I]MIBG scintigraphy 3 weeks after the onset of STEMI is a significant predictor of MACE in patients with STEMI, independent of LVEF.

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