Journal of Nuclear Cardiology

, Volume 5, Issue 6, pp 579–590

Cardiac death prediction and impaired cardiac sympathetic innervation assessed by MIBG in patients with failing and nonfailing hearts

  • Tomoaki Nakata
  • Kenjiroh Miyamoto
  • Atsushi Doi
  • Hisataka Sasao
  • Takeru Wakabayashi
  • Hiroshi Kobayashi
  • Kazufumi Tsuchihashi
  • Kazuaki Shimamoto
Original Articles

DOI: 10.1016/S1071-3581(98)90112-X

Cite this article as:
Nakata, T., Miyamoto, K., Doi, A. et al. J Nucl Cardiol (1998) 5: 579. doi:10.1016/S1071-3581(98)90112-X

Abstract

Background

Although cardiac sympathetic nerve dysfunction is related to poor clinical outcome, a critical sympathetic dysfunction level for predicting cardiac death is still unclear. The current study was designed to investigate which indices derived from metaiodobenzylguanidine (MIBG) imaging have prognostic value compared with clinical and cardiac function variables, and to determine the threshold of cardiac MIBG activity for identifying patients likely to suffer cardiac death in both failing and nonfailing hearts.

Methods and Results

Myocardial I-123-MIBG activity was quantified as a heart-to-mediastinum ratio in 414 consecutive patients, 173 (42%) of whom had symptomatic heart failure. After cardiac function measurements, patients were followed up with an end-point of cardiac or noncardiac death. During a mean follow-up period of 22 months, 37 cardiac deaths occurred: 23 resulted from heart failure, 9 were sudden cardiac deaths, and 5 were fatal myocardial infarctions. Multivariate analysis using the Wald χ2 and the Cox proportional hazard model revealed that late heart-to-mediastinum ratio, the use of nitrates, early heart-to-mediastinum ratio, and left ventricular ejection fraction were independent predictors of cardiac death; late heart-to-mediastinum ratio, New York Heart Association (NYHA) class, the presence of previousmyocardial infarction, and age were independent predictors of heart failure and sudden cardiac death. Late heart-to-mediastinum ratio was the most powerful predictor of overall cardiac death among the variables. The Kaplan-Meier analysis showed that a late heart-to-mediastinum ratio of 1.74 or less, age greater than 60 years, the presence of myocardial infarction, and NYHA functional class 3 or 4 strongly indicated poor clinical outcomes. Furthermore, the more powerful incremental prognostic values were obtained by using MIBG imaging in combination with conventional clinical variables.

Conclusions

Impaired cardiac sympathetic innervation assessed by MIBG activity has the greatest potential for predicting cardiac death and may be useful for identifying a threshold level for selecting patients at risk for death by heart failure, sudden cardiac death, and fatal myocardial infarction.

Key Words

heart failure sudden cardiac death cardiac sympathetic nerve function metaiodobenzylguanidine prognosis 

Copyright information

© American Society of Nuclear Cardiology 1998

Authors and Affiliations

  • Tomoaki Nakata
    • 1
  • Kenjiroh Miyamoto
    • 1
  • Atsushi Doi
    • 1
  • Hisataka Sasao
    • 1
  • Takeru Wakabayashi
    • 1
  • Hiroshi Kobayashi
    • 1
  • Kazufumi Tsuchihashi
    • 1
  • Kazuaki Shimamoto
    • 1
  1. 1.Second Department of Internal MedicineSapporo Medical University School of MedicineSapporoJapan