This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yamada, T. Articles by Hoki, N. Search for Related Content PubMed PubMed Citation Articles by Yamada, T. Articles by Hoki, N.

CLINICAL STUDY: HEART FAILURE

Comparison of the prognostic value of cardiac iodine-123 metaiodobenzylguanidine imaging and heart rate variability in patients with chronic heart failure

A prospective study

Takahisa Yamada, MD^*,*, Tsuyoshi Shimonagata, MD^*, Masatake Fukunami, MD^*, Kazuaki Kumagai, MD^*, Hisakazu Ogita, MD, Akio Hirata, MD^*, Mitsutoshi Asai, MD^*, Nobuhiko Makino, MD^*, Hidetaka Kioka, MD^*, Hideo Kusuoka, MD, Masatsugu Hori, MD and Noritake Hoki, MD^*

^* Division of Cardiology, Osaka Prefectural General Hospital, Osaka, Japan
Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Osaka, Japan
Institute for Clinical Research, Osaka National Hospital, Osaka, Japan

Manuscript received April 19, 2002; revised manuscript received August 26, 2002, accepted September 13, 2002.

^* Reprint requests and correspondence: Dr. Takahisa Yamada, Division of Cardiology, Osaka Prefectural Hospital, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan.
tyamada{at}gh.pref.osaka.jp

OBJECTIVES: We sought to prospectively compare the prognostic value of cardiac iodine-123 (I-123) metaiodobenzylguanidine (MIBG) imaging with that of heart rate variability (HRV) in patients with mild-to-moderate chronic heart failure (HF).

BACKGROUND: Cardiac I-123 MIBG imaging, which reflects cardiac adrenergic nerve activity, provides prognostic information on chronic HF patients. Reduced HRV, indicating derangement in cardiac autonomic control, was also reported to be associated with a poor prognosis in chronic HF patients.

METHODS: At study entry, I-123 MIBG imaging and 24-h Holter monitoring were performed in 65 chronic HF outpatients with a radionuclide left ventricular ejection fraction <40%. The cardiac MIBG heart to mediastinum ratio (H/M) and washout rate (WR) were obtained from MIBG imaging. The time and frequency domain parameters of HRV were calculated from 24-h Holter recordings.

RESULTS: At a mean follow-up of 34 ± 19 months, WR (p < 0.0001), H/M on the delayed image (p = 0.01), and normalized very-low-frequency power (n-VLFP) (p = 0.047) showed a significant association with the cardiac events (sudden death in 3 and hospitalization for worsening chronic HF in 10 patients) on univariate analysis. Multivariate analysis revealed that WR was the only independent predictor of cardiac events, although the predictive accuracy for the combination of abnormal WR and n-VLFP significantly increased, compared with that for abnormal WR (82% vs. 66%, p < 0.05).

CONCLUSIONS: Cardiac MIBG WR has a higher prognostic value than HRV parameters in patients with chronic HF. The combination of abnormal WR and n-VLFP would be useful to identify chronic HF patients at a higher risk of cardiac events.

Abbreviations and Acronyms   HF   heart failure   H/M   heart to mediastinum ratio   HRV   heart rate variability   I-123   iodine-123   LAD   left atrial dimension   LV   left ventricle, left ventricular   MIBG   metaiodobenzylguanidine   (n-)VLFP   (normalized) very-low-frequency power   R-LVEF   radionuclide left ventricular ejection fraction   ROI   region of interest   WR   washout rate

This article has been cited by other articles:

				J. Stirrup, A. Maenhout, K. Wechalekar, and C. Anagnostopoulos Radionuclide imaging in ischaemic heart failure Br. Med. Bull., August 26, 2009; (2009) ldp029v1. [Abstract] [Full Text] [PDF]

				S. Tamaki, T. Yamada, Y. Okuyama, T. Morita, S. Sanada, Y. Tsukamoto, M. Masuda, K. Okuda, Y. Iwasaki, T. Yasui, et al. Cardiac Iodine-123 Metaiodobenzylguanidine Imaging Predicts Sudden Cardiac Death Independently of Left Ventricular Ejection Fraction in Patients With Chronic Heart Failure and Left Ventricular Systolic Dysfunction Results From a Comparative Study With Signal-Averaged Electrocardiogram, Heart Rate Variability, and QT Dispersion. J. Am. Coll. Cardiol., February 3, 2009; 53(5): 426 - 435. [Abstract] [Full Text] [PDF]

				J. P. Piccini, J. R. Horton, L. K. Shaw, S. M. Al-Khatib, K. L. Lee, A. E. Iskandrian, and S. Borges-Neto Single-Photon Emission Computed Tomography Myocardial Perfusion Defects Are Associated With an Increased Risk of All-Cause Death, Cardiovascular Death, and Sudden Cardiac Death Circ Cardiovasc Imaging, November 1, 2008; 1(3): 180 - 188. [Abstract] [Full Text] [PDF]

				J. C. Gallego-Page Improvement in cardiac sympathetic nerve activity in responders to resynchronization therapy Europace, July 1, 2008; 10(7): 892 - 892. [Full Text] [PDF]

				H. J. Verberne, L. M. Brewster, G. A. Somsen, and B. L.F. van Eck-Smit Prognostic value of myocardial 123I-metaiodobenzylguanidine (MIBG) parameters in patients with heart failure: a systematic review Eur. Heart J., May 1, 2008; 29(9): 1147 - 1159. [Abstract] [Full Text] [PDF]

				H. Burri, H. Sunthorn, A. Somsen, E. Fleury, C. Stettler, D. Shah, and A. Righetti Improvement in cardiac sympathetic nerve activity in responders to resynchronization therapy Europace, March 1, 2008; 10(3): 374 - 378. [Abstract] [Full Text] [PDF]

				H. Kioka, T. Yamada, T. Mine, T. Morita, Y. Tsukamoto, S. Tamaki, M. Masuda, K. Okuda, M. Hori, and M. Fukunami Prediction of sudden death in patients with mild-to-moderate chronic heart failure by using cardiac iodine-123 metaiodobenzylguanidine imaging Heart, October 1, 2007; 93(10): 1213 - 1218. [Abstract] [Full Text] [PDF]