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Prognostic Value of Cardiac Sympathetic Nerve Imaging Using Long-Term Follow-up Data - Ischemic vs. Non-Ischemic
Shinro Matsuo1, Kenichi Nakajima, Tomoaki Nakata
1Department of Nuclear Medicine, Kanazawa University Hospital.
Insights
Cardiac (123)I-meta-iodobenzylguanidine (MIBG) imaging shows similar prognostic value for predicting outcomes in both ischemic and non-ischemic heart failure (HF). This cardiac imaging technique is effective regardless of the heart failure cause.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Heart failure (HF) prognosis determinants vary between ischemic and non-ischemic etiologies.
- Cardiac (123)I-meta-iodobenzylguanidine (MIBG) imaging is a diagnostic tool for HF.
- The prognostic efficacy of MIBG imaging in different HF etiologies requires investigation.
Purpose of the Study:
- To compare the prognostic value of cardiac MIBG imaging in patients with ischemic versus non-ischemic heart failure.
- To determine if MIBG imaging's predictive accuracy differs based on the underlying cause of heart failure.
Main Methods:
- A cohort of 1,322 heart failure patients was analyzed.
- Patients were categorized into ischemic (n=362) and non-ischemic (n=960) groups.
- Cox proportional hazards models were used to assess predictors of mortality over a 10-year follow-up.
Main Results:
- Overall mortality was 22.4% over 10 years, with similar rates in both groups.
- Ischemic HF showed higher sudden death/myocardial infarction rates; non-ischemic HF had more pump failure deaths.
- Delayed heart-to-mediastinum ratio (HMR) on MIBG imaging was a significant predictor of mortality in both ischemic and non-ischemic HF groups, alongside age and NYHA class.
Conclusions:
- Cardiac MIBG imaging demonstrates comparable prognostic utility in both ischemic and non-ischemic heart failure.
- The predictive value of MIBG imaging is independent of the specific cause of heart failure.
Background:
Although there are several known prognostic determinants in heart failure (HF), individual risk profiles can vary, in particular between ischemic and non-ischemic HF background. This study investigated the difference in prognostic efficacy of cardiac (123)I-meta-iodobenzylguanidine (MIBG) imaging between the 2 etiologies.
Methods And Results:
All 1,322 patients with HF were enrolled and followed up at most after 10 years. The HF patients were divided into 2 groups: an ischemic group (n=362) and non-ischemic group (n=960), and Cox proportional hazards model was used for data analysis. During 10 years of follow-up, 296 (22.4%) of 1,322 patients died; the mortality rates were 21.8% and 22.6% for the ischemic and non-ischemic groups, respectively. The ischemic group had greater prevalence of sudden death and lethal acute myocardial infarction, and the non-ischemic group had a higher rate of pump failure death. On multivariate Cox proportional hazards analysis using categorized variables, in the ischemic group, delayed heart-to-mediastinum ratio (HMR; P<0.0001), age (P=0.0002) and LVEF (P=0.03) were the independent significant predictors of lethal events. In the non-ischemic group, delayed HMR (P<0.0001), NYHA class (P<0.0001) and age (P<0.0001) were significant determinants of lethal outcome.
Conclusions:
Cardiac MIBG imaging has nearly identical prognostic value in both ischemic and non-ischemic HF, independent of cause of cardiac death.
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