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Predictors of outcome in patients with de novo diagnosis of heart failure with reduced ejection fraction: Role of combined myocardial and lung Iodine-123 Meta-Iodobenzylguanidine imaging

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The predictors of outcome in patients with de novo diagnosis of heart failure (HF) with reduced ejection fraction (HFrEF) are poorly known.

Methods and Results

All consecutive HFrEF patients admitted between October 2012 and November 2017 with their first episode of HF were scheduled for an outpatient follow-up. After 3 months, patients with confirmed HFrEF underwent Iodine-123 Meta-Iodobenzylguanidine imaging. We defined three study endpoints: HF rehospitalization, cardiac death and all-cause death. Eighty-four patients were enrolled. During follow-up (39.9 ± 18.6 months) HF rehospitalization occurred in 33 cases, cardiac death in 18 and all-cause death in 24. At multivariate analysis, systolic pulmonary arterial pressure (sPAP; HR: 1.047; p = .027) and Late lung to heart ratio (L/H; HR: 1.341; p < .001) independently predict HF rehospitalization; left ventricular end-systolic volume (LVESV; HR: 1.016; p = .017), sPAP (HR: 1.064; p = .034) and Late L/H (HR: 1.323; p = .009) were predictors of cardiac death; LVESV (HR: 1.013; p = .018) and Late L/H (HR: 1.245; p = .012) were independent predictors of all-cause death. Kaplan–Meier analysis of the individual predictors confirmed their prognostic ability during follow-up; of note, the Late L/H cut-off of 1.1 improved the risk stratification capability of echocardiographic parameters.

Conclusions

Late L/H independently predicts HF rehospitalization, cardiac death and all-cause death in patients with de novo diagnosis of HFrEF and improves the prognostic stratification capability of conventional echocardiographic parameters.

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Abbreviations

HF:

Heart failure

HFrEF:

Heart failure with reduced ejection fraction

H/M:

Heart to mediastinum ratio

123I-mIBG:

Iodine-123 Meta-Iodobenzylguanidine

L/H:

Lung to heart ratio

L/M:

Lung to mediastinum ratio

LVEF:

Left ventricular ejection fraction

LVESV:

Left ventricular end-systolic volume

NYHA:

New York Heart Association

sPAP:

Systolic pulmonary artery pressure

References

  1. Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola VP, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: An analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail 2017;19:1574-85.

    Article  CAS  Google Scholar 

  2. Zile MR, Gaasch WH, Anand IS, Haass M, Little WC, Miller AB, et al. Mode of death in patients with heart failure and a preserved ejection fraction: Results from the Irbesartan in Heart Failure With Preserved Ejection Fraction Study (I-Preserve) trial. Circulation 2010;121:1393-405.

    Article  Google Scholar 

  3. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37:2129-200.

    Article  Google Scholar 

  4. Kirkpatrick JN, Vannan MA, Narula J, Lang RM. Echocardiography in heart failure: applications, utility, and new horizons. J Am Coll Cardiol 2007;50:381-96.

    Article  Google Scholar 

  5. Leimbach WN Jr, Wallin BG, Victor RG, Aylward PE, Sundlof G, Mark AL. Direct evidence from intraneural recordings for increased central sympathetic outflow in patients with heart failure. Circulation 1986;73:913-9.

    Article  Google Scholar 

  6. Travin MI. Cardiac radionuclide imaging to assess patients with heart failure. Semin Nucl Med 2014;44:294-313.

    Article  Google Scholar 

  7. Slosman DO, Davidson D, Brill AB, Alderson PO. 131 I-metaiodobenzylguanidine uptake in the isolated rat lung: A potential marker of endothelial cell function. Eur J Nucl Med 1988;13:543-7.

    Article  CAS  Google Scholar 

  8. Richalet JP, Merlet P, Bourguignon M, Vaysse J, Larmignat P, Boom NA. MIBG scintigraphic assessment of cardiac adrenergic activity in response to altitude hypoxia. J Nucl Med 1990;31:34-7.

    CAS  PubMed  Google Scholar 

  9. Kamiyoshi Y, Yazaki Y, Urushibata K, Koizumu T, Kasai H, Izawa A, et al. Risk stratification assessed by combined lung and heart iodine-123 metaiodobenzylguanidine uptake in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2008;101:1482-6.

    Article  CAS  Google Scholar 

  10. Higo K, Kubota K, Miyanaga S, Miyata M, Nakajo M, Jinguji M, et al. Impairment of iodine-123-metaiodobenzylguanidine (123 I-MIBG) uptake in patients with pulmonary artery hypertension. Int Heart J 2018;59:112-9.

    Article  CAS  Google Scholar 

  11. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012;33:1787-847.

    Article  Google Scholar 

  12. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande 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 

  13. Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: A report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2017;30:303-71.

    Article  Google Scholar 

  14. Flotats A, Carrió I, Agostini D, Le Guludec D, Marcassa C, Schäfers M, et al. Proposal for standardization of 123I-metaiodobenzylguanidine (MIBG) cardiac sympathetic imaging by the EANM Cardiovascular Committee and the European Council of Nuclear Cardiology. Eur J Nucl Med Mol Imaging 2010;37:1802-12.

    Article  Google Scholar 

  15. Maggioni AP, Dahlström U, Filippatos G, Chioncel O, Crespo Leiro M, Drozdz J, et al. EURObservational Research Programme: Regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 2013;15:808-17.

    Article  Google Scholar 

  16. Tavazzi L, Senni M, Metra M, Gorini M, Cacciatore G, Chinaglia A, et al. Multicenter prospective observational study on acute and chronic heart failure: One-year follow-up results of IN-HF (Italian Network on Heart Failure) outcome registry. Circ Heart Fail 2013;6:473-81.

    Article  CAS  Google Scholar 

  17. Jones RC, Francis GS, Lauer MS. Predictors of mortality in patients with heart failure and preserved systolic function in the Digitalis Investigation Group trial. J Am Coll Cardiol 2004;44:1025-9.

    Article  Google Scholar 

  18. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: The CHARM-Preserved Trial. Lancet 2003;362:777-81.

    Article  CAS  Google Scholar 

  19. Stanton T, Jenkins C, Haluska BA, Marwick TH. Association of outcome with left ventricular parameters measured by two-dimensional and three-dimensional echocardiography in patients at high cardiovascular risk. J Am Soc Echocardiogr 2014;27:65-73.

    Article  Google Scholar 

  20. Wong M, Staszewsky L, Latini R, Barlera S, Glazer R, Aknay N, et al. Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure. J Am Coll Cardiol 2004;43:2022-7.

    Article  Google Scholar 

  21. Grayburn PA, Appleton CP, DeMaria AN, Greenberg B, Lowes B, Oh J, et al. Echocardiographic predictors of morbidity and mortality in patients with advanced heart failure: The Beta-blocker Evaluation of Survival Trial (BEST). J Am Coll Cardiol 2005;45:1064-71.

    Article  Google Scholar 

  22. Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: Prevalence and mortality in a population-based cohort. J Am Coll Cardiol 1999;33:1948-55.

    Article  CAS  Google Scholar 

  23. Abramson SV, Burke JF, Kelly JJ Jr, Kitchen JG 3rd, Dougherty MJ, Yih DF, et al. Pulmonary hypertension predicts mortality and morbidity in patients with dilated cardiomyopathy. Ann Intern Med 1992;116:888-95.

    Article  CAS  Google Scholar 

  24. Bursi F, McNallan SM, Redfield MM, Nkomo VT, Lam CS, Weston SA, et al. Pulmonary pressures and death in heart failure: A community study. J Am Coll Cardiol 2012;17:222-31.

    Article  Google Scholar 

  25. Ghio S, Temporelli PL, Klersy C, Simioniuc A, Girardi B, Scelsi L, et al. Prognostic relevance of a non-invasive evaluation of right ventricular function and pulmonary artery pressure in patients with chronic heart failure. Eur J Heart Fail 2013;15:408-14.

    Article  Google Scholar 

  26. Brunner-La Rocca HP, Esler MD, Jennings GL, Kay DM. Effect of cardiac nervous activity on mode of death in congestive heart failure. Eur Heart J 2001;22:1136-43.

    Article  CAS  Google Scholar 

  27. Verberne HJ, Brewster LM, Somsen GA, van Eck-Smit BL. Prognostic value of myocardial 123I-MIBG -metaiodobenzylguanidine (MIBG) parameters in patients with heart failure: A systematic review. Eur Heart J 2008;29:1147-59.

    Article  Google Scholar 

  28. Jacobson AF, Senior R, Cerqueira MD, Wong ND, Thomas GS, Lopez VA, et al. Myocardial iodine-123 meta-iodobenzylguanidine imaging and cardiac events in heart failure. Results of the prospective ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) study. J Am Coll Cardiol 2010;55:2212-21.

    Article  Google Scholar 

  29. Arao T, Takabatake N, Sata M, Abe S, Shibata Y, Honma T, et al. In vivo evidence of endothelial injury in chronic obstructive pulmonary disease by lung scintigraphic assessment of (123)I-metaiodobenzylguanidine. J Nucl Med 2003;44:1747-54.

    PubMed  Google Scholar 

  30. Mu X, Hasegawa S, Yoshioka J, Maruyama A, Maruyama K, Paul AK, et al. Clinical value of lung uptake of iodine-123 metaiodobenzylguanidine (MIBG), a myocardial sympathetic nerve imaging agent, in patients with chronic heart failure. Ann Nucl Med 2001;15:411-6.

    Article  CAS  Google Scholar 

  31. Unlu M, Inanir S. Prolonged lung retention of iodine-123-MIBG in diabetic patients. J Nucl Med 1998;39:116-8.

    CAS  PubMed  Google Scholar 

  32. Murashima S, Takeda K, Matsumura K, Yamakado K, Sakuma H, Kitano T, et al. Increased lung uptake of iodine-123-MIBG in diabetics with sympathetic nervous dysfunction. J Nucl Med 1998;39:334-8.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy

    Angelo Silverio MD, Maria Vincenza Polito MD, Federica D’Auria MD, Gennaro Vitulano MD, Rodolfo Citro MD, PhD, Gennaro Galasso MD, PhD & Federico Piscione MD

  2. Dipartimento di Medicina, Chirurgia ed Odontoiatria “Scuola Medica Salernitana”, Università degli Studi di Salerno, Fisciano, Italy

    Leonardo Pace MD, Gennaro Galasso MD, PhD & Federico Piscione MD

  3. U.O.C. Medicina Nucleare, Dipartimento di Diagnostica per Immagini e Radioterapia, A.O.U. San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy

    Massimo Scarano MD

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Silverio, A., Polito, M.V., Pace, L. et al. Predictors of outcome in patients with de novo diagnosis of heart failure with reduced ejection fraction: Role of combined myocardial and lung Iodine-123 Meta-Iodobenzylguanidine imaging. J. Nucl. Cardiol. 28, 72–85 (2021). https://doi.org/10.1007/s12350-019-01637-8

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