Prognostic value of serial cardiac 123I-MIBG Imaging in patients with stabilized chronic heart failure and reduced left ventricular ejection fraction
Prognostic value of serial cardiac 123I-MIBG Imaging in patients with stabilized chronic heart failure and reduced left ventricular ejection fraction
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DOI：
10.2967/jnumed.107.047548
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发表时间：
2008-06-01
影响因子：
9.3
通讯作者：
Kurabayashi, Masahiko
中科院分区：
文献类型：
--
作者：
Kasama, Shu;Toyama, Takuji;Kurabayashi, Masahiko
许多研究表明，在稳定期进行一次性I-123-间碘苄胍（I-123-MIBG）血流图检查有助于确定慢性心力衰竭（CHF）患者的预后。然而，众所周知，通过心力衰竭的药物治疗可以改善这种成像方式的结果。因此，进行本研究以确定连续I-123-MIBG放射性造影研究是否代表CHF患者的可靠预后标志物。研究方法：根据需要住院治疗的失代偿性急性心力衰竭病史，共确定了208例CHIF患者（左心室射血分数[LVEF] < 45%），至少5个月内无心脏事件。根据患者出院前和接受6个月治疗后的I-123-MIBG图像确定延迟的去神经百分比（%去神经）、延迟的心脏-纵隔计数（HM比）和洗脱率（WR）。在相同时间点通过超声心动图测定左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）和LVEF。结果：在208例患者中，56例在研究期间发生了致死性心脏事件。平均随访时间为4.45 ± 1.82年。心源性死亡组的基线H/M比和WR;随访06去神经、H/M比和WR; Δ-%去神经、H/M比和WR;基线LVEF;随访LVEDV、LVESV和LVEF;以及Δ-LVEDV、Δ-LVESV和Δ-LVEF显著更差。考克斯回归分析显示，Delta-WR是心源性死亡的独立预测因子。此外，56例心源性死亡患者中有13例发生猝死。一项考克斯回归分析也显示，Delta-WR是猝死的增量预测因子。Delta-WR <-5%和Delta-WR <-2%的患者的无心源性死亡率和无猝死率显著高于Delta-WR ≥-5%和Delta-WR ≥-2%的患者。结论：从I-123-MIBG连续血流图研究中获得的Delta-WR可用于预测稳定的CHF患者的心源性死亡和猝死。
Many studies have shown that a one-time I-123-metaiodobenzylguanidine (I-123-MIBG) scintigraphic study during a stable period is useful for determining the prognosis of patients with chronic heart failure (CHF). However, the findings from this imaging modality are well known to be improved by medical treatment for heart failure. Accordingly, this study was performed to determine whether serial I-123-MIBG scintigraphic studies represent a reliable prognostic marker for patients with CHF. Methods: A total of 208 patients with CHIF (left ventricular ejection fraction [LVEF] < 45%) and with no cardiac events for at least 5 mo were identified on the basis of a history of decompensated acute heart failure requiring hospitalization. The delayed percentage of denervation (% denervation), delayed heart-to-mediastinum count (H M ratio, and washout rate (WR) were determined from the patients' I-123-MIBG images just before they left the hospital and after they had received 6 mo of treatment. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and LVEF were also determined by echocardiography at the same time points. Results: Of the 208 patients, 56 experienced fatal cardiac events during the study. The mean follow-up period was 4.45 +/- 1.82 y. The baseline H/M ratio and WR; follow-up 06 denervation, H/M ratio, and WR; Delta-% denervation, H/M ratio, and WR; baseline LVEF; follow-up LVEDV, LVESV, and LVEF; and Delta-LVEDV, Delta-LVESV, and Delta-LVEF were significantly worse in the cardiac death group. A Cox regression analysis showed that the Delta-WR was an independent predictor of cardiac death. Moreover, sudden death occurred in 13 of the 56 patients with cardiac death. A Cox regression analysis also showed that the Delta-WR was an incremental predictor of sudden death. The cardiac death-free rate and sudden death-free rate were significantly higher in patients with Delta-WR less than -5% and Delta-WR less than -2% than in patients with Delta-WR greater than or equal to -5% and Delta-WR greater than or equal to -2%. Conclusion: Delta-WR obtained from serial I-123-MIBG scintigraphic studies can be useful for predicting cardiac death and sudden death in stabilized patients with CHF.