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Cardiac sympathetic activity in patients suffering from heart failure with improved ejection fraction
Yohei Ishibashi1, Shu Kasama2, Hideki Ishii3
1Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Japan; Department of Cardiovascular Medicine, Kyorin University Hospital, Japan.
Insights
Patients with heart failure (HF) who improved their ejection fraction (EF) showed lower cardiac sympathetic nerve activity. A higher heart-to-mediastinal ratio on MIBG scans predicts this improvement in HF patients.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Heart Failure Research
Background:
- Cardiac sympathetic nerve activity in heart failure with improved ejection fraction (HFimpEF) is not well understood.
- Heart failure (HF) patients with EF ≤ 40% were studied to clarify HFimpEF characteristics.
Purpose of the Study:
- To investigate cardiac sympathetic nerve activity in HF patients who improve their ejection fraction (EF).
- To identify predictors of improved EF in heart failure patients.
Main Methods:
- 188 HF patients with EF ≤ 40% underwent echocardiography and 123I-metaiodobenzylguanidine (MIBG) scintigraphy.
- Patients were followed for 5.2 years, categorized into HFimpEF (EF >40%) and HFrEF (EF ≤40%) groups at 6 months.
Main Results:
- The HFimpEF group (78 patients) had a higher baseline heart-to-mediastinal (H/M) ratio than the HFrEF group (110 patients).
- Predictors for HFimpEF included ischemic heart disease, higher H/M ratio, and higher EF.
- The H/M ratio was identified as an independent predictor of HFimpEF.
Conclusions:
- HFimpEF patients exhibit lower cardiac sympathetic hyperactivity compared to HFrEF patients, indicated by a higher H/M ratio.
- The H/M ratio is a significant independent predictor for improved ejection fraction in heart failure.
Background:
The characteristics of cardiac sympathetic nerve activity among patients suffering from heart failure (HF) with improved ejection fraction (EF) (HFimpEF) remain unclear.
Methods:
Patients admitted for HF with an EF ≤ 40% who underwent echocardiography and 123I-metaiodobenzylguanidine scintigraphy before and 6 months after discharge were followed for 5.2 (2.8-6.1) years. At 6 months, patients with an EF ≤ 40% were classified into the HF with reduced EF (HFrEF) group. Meanwhile, patients with an EF of >40% were classified under the HFimpEF group.
Results:
Among the 188 patients analyzed, 78 (41.5%) and 110 (58.5%) were categorized into the HFimpEF and HFrEF groups, respectively. The HFimpEF group had a better heart-to-mediastinal (H/M) ratio at baseline than did the HFrEF group (1.76 [1.59-1.85] vs 1.64 [1.48-1.81], respectively; P = .011). The predictive factors of HFimpEF included ischemic heart disease (odds ratio [OR]: .45, 95% confidence interval [CI]: .21-.94, P = .034), H/M ratio (OR: 1.02, 95% CI: 1.00-1.04, P = .032), and EF (OR: 1.14, 95% CI: 1.08-1.21, P < .001).
Conclusions:
The HFimpEF group had a higher H/M ratio than did the HFrEF group, suggesting lower cardiac sympathetic hyperactivity. The H/M ratio was identified as an independent predictor of HFimpEF.
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