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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

View larger version (84K): [in a new window]   Figure 1 Iodine-123 metaiodobenzylguanidine (MIBG) imaging in a patient with chronic heart failure (HF). Heart (H) and mediastinum (M) were selected, as shown, to measure the H/M ratio. The cardiac MIBG washout rate (WR) was calculated from the initial (left) and delayed images (right).

View larger version (25K): [in a new window]   Figure 2 Plots of data of cardiac metaiodobenzylguanidine (MIBG) imaging in patients with chronic heart failure with and without cardiac events. H/M(e) and H/M(d) denote the cardiac MIBG heart to mediastinum ratio (H/M) on the early and delayed images, respectively. Patients with cardiac events had a significantly lower H/M(d) and higher washout rate (WR) than did those without cardiac events, although there was no significant difference in H/M(e) between the two groups.

View larger version (16K): [in a new window]   Figure 3 The cardiac event-free rate curves by Kaplan-Meier analysis in patients with chronic heart failure with and without an abnormal washout rate (WR) (>27%). The cardiac event-free rate was significantly lower in patients with an abnormal WR than in those without it.

View larger version (15K): [in a new window]   Figure 4 The cardiac event-free rate curves by Kaplan-Meier analysis in patients with chronic heart failure with and without abnormal normalized very-low-frequency power (n-VLFP) (<22). The cardiac event-free rate was significantly lower in patients with abnormal n-VLFP than in those without it.

View larger version (15K): [in a new window]   Figure 5 The cardiac event-free rate curves by Kaplan-Meier analysis in patients with chronic heart failure, according to a combination of abnormal washout rate (WR) and normalized very-low-frequency power (n-VLFP). The cardiac event-free rate was significantly lower in patients with both an abnormal WR and n-VLFP than in those with both a normal WR and n-VLFP.