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CLINICAL STUDIES

Cardiac metaiodobenzylguanidine uptake in patients with moderate chronic heart failure: relationship with peak oxygen uptake and prognosis

Alain Cohen-Solal, MD, PhD, FESC^*, Yves Esanu, MD^*, Damien Logeart, MD^*, Fabienne Pessione, MD^*, Claude Dubois, MD, Gilles Dreyfus, MD, René Gourgon, MD^* and Pascal Merlet, MD, PhD

^* Hôpitaux Beaujon, Clichy, France
Foch, Suresnes, France
Centre Hospitalier Frederic Joliot, Orsay, France

Manuscript received May 19, 1998; revised manuscript received September 28, 1998, accepted November 5, 1998.

Reprint requests and correspondence: Pr. Alain Cohen-Solal, Service de Cardiologie, Hôpital Beaujon, 100 Boulevard du General Leclerc, 92110 Clichy, France
alain.cohen-solal{at}bjn.ap-hop-paris.fr

OBJECTIVES

This prospective study was undertaken to correlate early and late metaiodobenzylguanidine (MIBG) cardiac uptake with cardiac hemodynamics and exercise capacity in patients with heart failure and to compare their prognostic values with that of peak oxygen uptake (VO₂).

BACKGROUND

The cardiac fixation of MIBG reflects presynaptic uptake and is reduced in heart failure. Whether it is related to exercise capacity and has better prognostic value than peak VO₂ is unknown.

METHODS

Ninety-three patients with heart failure (ejection fraction <45%) were studied with planar MIBG imaging, cardiopulmonary exercise tests and hemodynamics (n = 44). Early (20 min) and late (4 h) MIBG acquisition, as well as their ratio (washout, WO) were determined. Prognostic value was assessed by survival curves (Kaplan–Meier method) and uni- and multivariate Cox analyses.

RESULTS

Late cardiac MIBG uptake was reduced (131 ± 20%, normal values 192 ± 42%) and correlated with ejection fraction (r = 0.49), cardiac index (r = 0.40) and pulmonary wedge pressure (r = –0.35). There was a significant correlation between peak VO₂ and MIBG uptake (r = 0.41, p < 0.0001). With a mean follow-up of 10 ± 8 months, both late MIBG uptake (p = 0.04) and peak VO₂ (p < 0.0001) were predictive of death or heart transplantation, but only peak VO₂ emerged by multivariate analysis. Neither early MIBG uptake nor WO yielded significant insights beyond those provided by late MIBG uptake.

CONCLUSIONS

Metaiodobenzylguanidine uptake has prognostic value in patients with wide ranges of heart failure, but peak VO₂ remains the most powerful prognostic index.

Abbreviations and Acronyms   CHF = chronic heart failure   EF = ejection fraction   H/M = heart/mediastinum   MIBG = metaiodobenzylguanidine   NYHA = New York Heart Association   ROC = receiver operating characteristic   VO2 = oxygen uptake   WO = wash-out

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