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Prognostic values of 123I-MIBG myocardial scintigraphy and heart rate variability in patients with heart failure with preserved ejection fraction

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The aim of this study was to evaluate the prognostic values of sympathetic nerve system using 123I-MIBG myocardial scintigraphy and using Holter electrocardiogram (ECG) in patients with heart failure with preserved ejection fraction (HFpEF).

Methods and results

Among 403 consecutive patients with stable HF who underwent 123I-MIBG myocardial scintigraphy and Holter ECG, we identified 133 patients (64 ± 16 years) who had preserved ejection fraction (≥ 50%) by echocardiography. Multivariate Cox model was used to assess if washout rate (WR) by 123I-MIBG scintigraphy and very low frequency power (VLFP) by Holter ECG was associated with major adverse cardiovascular events (MACE). During a mean follow-up of 5.4 ± 4.1 years, 39 MACE occurred. The lower nighttime VLFP (HR 3.29, 95% CI 1.56 to 6.92) and higher WR (HR 4.01, 95% CI 1.63 to 9.88) were the significant prognostic factors for MACE. As compared to high nighttime VLFP and low WR group, MACE risk was significantly the highest in the low nighttime VLFP and high WR group (HR 40.832; 95% CI 5.378 to 310.012, P < 0.001).

Conclusion

This study demonstrated that the nighttime VLFP adding to WR could be a potential prognostic value among patients with HFpEF.

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Abbreviations

HFpEF:

Heart failure with preserved left ventricular ejection fraction

HRV:

Heart rate variability

SDNN:

Standard deviation of all normal to normal intervals

VLFP:

Very low frequency power

LFP:

Low-frequency power

HFP:

High-frequency power

WR:

Washout rate

AUC:

Area under the curve

ROC:

Receiver operating characteristic

MACE:

Major adverse cardiac events

References

  1. Levy WC, Anand IS. Heart failure risk prediction models: What have we learned? JACC Heart Fail. 2014;2:437–9.

    Article  Google Scholar 

  2. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–9.

    Article  CAS  Google Scholar 

  3. Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370:1383–92.

    Article  CAS  Google Scholar 

  4. Packer M. The neurohumoral hypothesis: A theory to explain the mechanism of disease progression in heart failure. J Am Coll Cardiol. 1992;20:248–54.

    Article  CAS  Google Scholar 

  5. Agostini D, Carrio I, Verberne HJ. How to use myocardial 123I-MIBG scintigraphy in chronic heart failure. Eur J Nucl Med Mol Imaging. 2009;36:555–9.

    Article  Google Scholar 

  6. Fujimoto S, Inoue A, Hisatake S, Yamashina S, Yamashina H, Nakano H, et al. Usefulness of meta-[123I]iodobenzylguanidine myocardial scintigraphy for predicting cardiac events in patients with dilated cardiomyopathy who receive long-term beta blocker treatment. Nucl Med Commun. 2005;26:97–102.

    Article  CAS  Google Scholar 

  7. Katoh S, Shishido T, Kutsuzawa D, Arimoto T, Netsu S, Funayama A, et al. Iodine-123-metaiodobenzylguanidine imaging can predict future cardiac events in heart failure patients with preserved ejection fraction. Ann Nucl Med. 2010;24:679–86.

    Article  Google Scholar 

  8. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: Standard of measurement, physiological interpretation, and clinical use. Circulation. 1996;93:1043–65.

    Article  Google Scholar 

  9. Bonaduce D, Petretta M, Marciano F, Vicario ML, Apicella C, Rao MA, et al. Independent and incremental prognostic value of heart rate variability in patients with chronic heart failure. Am Heart J. 1999;138:273–84.

    Article  CAS  Google Scholar 

  10. Kurata C, Shouda S, Mikami T, Uehara A, Ishikawa K, Tawarahara K, et al. Metaiodobenzylguanidine and heart rate variability in heart failure. Jpn Circ J. 1998;62:770–2.

    Article  CAS  Google Scholar 

  11. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Emande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1–39.

    Article  Google Scholar 

  12. Jessup M, Marwick TH, Ponikowski P, Voors AA, Yancy CW. 2016 ESC and ACC/AHA/HFSA heart failure guideline update—What is new and why is it important? Nat Rev Cardiol. 2016;13:623–8.

    Article  Google Scholar 

  13. Ohtomo N, Terachi S, Tanaka Y, Tokiwano K, Kaneko N. New method of time series analysis and its application to Wolf’s sunspot number data. Jpn J Appl Phys. 1994;33:2821–31.

    Article  Google Scholar 

  14. Donal E, Lund LH, Oqer E, Hage C, Persson H, Reynaud A, et al. New echocardiographic predictors of clinical outcome in patients presenting with heart failure and a preserved left ventricular ejection fraction: A subanalysis of the Ka (Karolinska) Ren (Rennes) Study. Eur J Heart Fail. 2015;17:680–8.

    Article  CAS  Google Scholar 

  15. Kizman DW, Little WC, Brubaker PH, Anderson RT, Hundley WG, Marburger CT, et al. Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure. JAMA. 2002;288:2144–50.

    Article  Google Scholar 

  16. Levi R, Silver RB, Mackins CJ, Seyedi N, Koyama M. Activation of a renin-angiotensin system in ischemic cardiac sympathetic nerve endings and its association with norepinephrine release. Int Immunopharmacol. 2002;2:1965–73.

    Article  CAS  Google Scholar 

  17. Yamada T, Shimonagata T, Fukunami M, Kumagai K, Ogita H, Hirata A, et al. Comparison of the prognostic value of cardiac iodine-123 metaiodobenzylguanidine imaging and heart rate variability in patients with chronic heart failure: a prospective study. J Am Coll Cardiol. 2003;41:231–8.

    Article  Google Scholar 

  18. Bigger JT, Fleiss JL, Steinman RC, Rolnitzky LM, Kleiger RE, Rottman JN. Frequency domain measures of heart rate variability and mortality after myocardial infarction. Circulation. 1992;85:164–71.

    Article  Google Scholar 

  19. Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation. 1991;84:482–92.

    Article  CAS  Google Scholar 

  20. Parti G, Saul JP, Di Rieuzo M, Mancia G. Spectral analysis of blood pressure and heart rate variability in evaluating cardiovascular regulation: A critical appraisal. Hypertension. 1995;25:1276–86.

    Article  Google Scholar 

  21. Morata A, Sleight P, Pinna GD, Maestri R, Prpa A, La Rovere MT, et al. Abnormal awake respiratory patters are common in chronic heart failure and may prevent evaluation of autonomic tone by measures of heart rate variability. Circulation. 1997;96:246–52.

    Article  Google Scholar 

  22. Ushijima R, Joho S, Akabane T, Oda Y, Inoue H. Differing effects of adaptive servoventilation and continuous positive airway pressure on muscle sympathetic nerve activity in patients with heart failure. Circ J. 2014;78:1387–95.

    Article  Google Scholar 

  23. Kario K. Morning surge and variability in blood pressure: a new therapeutic target? Hypertension. 2005;45:485–6.

    Article  CAS  Google Scholar 

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Acknowledgments

We are grateful to the radiology technologists Mr. Tadashi Kokubo, Mr. Kazuhiro Tachiki, Mr. Nobutomo Ishii, and Mr. Takushi Ookubo for their technical assistance in the administration of myocardial 123I-MIBG scintigraphy, and to the clinical physiology technologist Mr. Naoji Masuya for his technical assistance in Holter ECG.

Disclosures

Takanori Ikeda has received Grant support through his institution from Daiichi Sankyo, Bristol-Myers Squibb, Boehringer Ingelheim; and honoraria for lectures from Bayer Healthcare, Daiichi Sankyo, Bristol-Myers Squibb, Pfizer, Tanabe-Mitsubishi, and Ono Pharmaceutical. Regarding this study, all authors declare that there is no potential conflict of interest.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan

    Hidenobu Hashimoto MD, PhD, Rine Nakanishi MD, PhD, Yukiko Hashimoto MD, PhD, Yuriko Okamura MD, Kyoko Yamanaka MD, Junichi Yamazaki MD, PhD & Takanori Ikeda MD, PhD

  2. Department of Radiology, Toho University Faculty of Medicine, Tokyo, Japan

    Sunao Mizumura MD, PhD

Authors
  1. Hidenobu Hashimoto MD, PhD
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  2. Rine Nakanishi MD, PhD
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  3. Sunao Mizumura MD, PhD
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  4. Yukiko Hashimoto MD, PhD
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  5. Yuriko Okamura MD
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  6. Kyoko Yamanaka MD
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  7. Junichi Yamazaki MD, PhD
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  8. Takanori Ikeda MD, PhD
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Corresponding author

Correspondence to Hidenobu Hashimoto MD, PhD.

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Hashimoto, H., Nakanishi, R., Mizumura, S. et al. Prognostic values of 123I-MIBG myocardial scintigraphy and heart rate variability in patients with heart failure with preserved ejection fraction. J. Nucl. Cardiol. 27, 833–842 (2020). https://doi.org/10.1007/s12350-018-01494-x

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  • DOI: https://doi.org/10.1007/s12350-018-01494-x

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