Cardiac Iodine-123 Metaiodobenzylguanidine Imaging Predicts Sudden Cardiac Death Independently of Left Ventricular Ejection Fraction in Patients With Chronic Heart Failure and Left Ventricular Systolic Dysfunction : Results From a Comparative Study With Signal-Averaged Electrocardiogram, Heart Rate Variability, and QT Dispersion

• Published in: Journal of the American College of Cardiology Vol. 53; no. 5; pp. 426 - 435
• Main Authors: TAMAKI, Shunsuke, YAMADA, Takahisa, HORI, Masatsugu, FUKUNAMI, Masatake, OKUYAMA, Yuji, MORITA, Takashi, SANADA, Shoji, TSUKAMOTO, Yasumasa, MASUDA, Masaharu, OKUDA, Keiji, IWASAKI, Yusuke, YASUI, Taku
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 03-02-2009; Elsevier Limited
• Subjects: 3-Iodobenzylguanidine; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antidepressants; Beta blockers; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular system; Chronic Disease; Confidence intervals; Death, Sudden, Cardiac - prevention & control; Drug therapy; Electrocardiography, Ambulatory; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Female; Fractions; Heart; Heart attacks; Heart failure; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Failure, Systolic - diagnostic imaging; Heart Rate; Humans; Intensive care medicine; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Maximum entropy method; Medical imaging; Medical sciences; Middle Aged; Monitoring systems; Mortality; Multivariate analysis; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Severity of Illness Index; Standard deviation; Stroke Volume; Ventricular Dysfunction, Left - diagnostic imaging; Japan; Heart; Variability; Cardiovascular disease; Heart ventricle; Left ventricular failure; Result; Electrodiagnosis; Signal; Heart disease; Electrocardiography; Ventricular ejection; Cardiology; Left ventricle performance; Iodine; Human; Heart failure; QT interval; Sudden death; Prediction; Dispersion; Left ventricle; Heart rate; Chronic; Medical imagery; Circulatory system; Hemodynamics; Comparative study; Ejection fraction
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2008.10.025

We prospectively compared the predictive value of cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging for sudden cardiac death (SCD) with that of the signal-averaged electrocardiogram (SAECG), heart rate variability (HRV), and QT dispersion in patients with chronic heart failure (CHF).
Cardiac MIBG imaging predicts prognosis of CHF patients. However, the long-term predictive value of MIBG imaging for SCD in this population remains to be elucidated.
At entry, cardiac MIBG imaging, SAECG, 24-h Holter monitoring, and standard 12-lead electrocardiography (ECG) were performed in 106 consecutive stable CHF outpatients with a radionuclide left ventricular ejection fraction (LVEF) <40%. The cardiac MIBG washout rate (WR) was obtained from MIBG imaging. Furthermore, the time and frequency domain HRV parameters were calculated from 24-h Holter recordings, and QT dispersion was measured from the 12-lead ECG.
During a follow-up period of 65 +/- 31 months, 18 of 106 patients died suddenly. A multivariate Cox analysis revealed that WR and LVEF were significantly and independently associated with SCD, whereas the SAECG, HRV parameters, or QT dispersion were not. Patients with an abnormal WR (>27%) had a significantly higher risk of SCD (adjusted hazard ratio: 4.79, 95% confidence interval: 1.55 to 14.76). Even when confined to the patients with LVEF >35%, SCD was significantly more frequently observed in the patients with than without an abnormal WR (p = 0.02).
Cardiac MIBG WR, but not SAECG, HRV, or QT dispersion, is a powerful predictor of SCD in patients with mild-to-moderate CHF, independently of LVEF.