Prognostic value of MIBG imaging in idiopathic dilated cardiomyopathy.
Alterations of cardiac sympathetic innervation are likely to contribute to fatal outcomes in patients with heart failure. These alterations can be evaluated noninvasively by 123I-metaiodoben-zylguanidine (MIBG) imaging.


METHODS
The hypothesis that impaired cardiac sympathetic innervation, as assessed using MIBG imaging, is related to adverse outcomes was tested in 112 patients with heart failure resulting from idiopathic cardiomyopathy. Main inclusion criteria were New York Heart Association classes II-IV and radionuclide left ventricular ejection fraction (LVEF) < 40%. Patients were assessed for cardiac MIBG uptake, circulating norepinephrine concentration, LVEF, peak Vo2, x-ray cardiothoracic ratio, M-mode echographic end-diastolic diameter and right-sided heart catheterization parameters.


RESULTS
During a mean follow-up of 27 +/- 20 mo, 19 patients had transplants, 25 died of cardiac death (8 sudden deaths), 2 died of noncardiac death and 66 survived without transplantation. The only independent predictors for mortality were low MIBG uptake (P < 0.001) and LVEF (P = 0.02) when using multivariate discriminant analysis. Moreover, MIBG uptake (P < 0.001) and circulating norepinephrine concentration (P = 0.001) were the only independent predictors for life duration when using multivariate life table analysis.


CONCLUSIONS
Impaired cardiac adrenergic innervation as assessed by MIBG imaging is strongly related to mortality. MIBG imaging may help risk stratify patients with heart failure resulting from idiopathic dilated cardiomyopathy.
Merlet
P
P
Fédération de Cardiologie et de Chirurgie Cardio-vasculaire, Center Hospitalo-Universitaire Henri Mondor, Créteil, France.
Benvenuti
C
C
Moyse
D
D
Pouillart
F
F
Dubois-Randé
J L
JL
Duval
A M
AM
Loisance
D
D
Castaigne
A
A
Syrota
A
A
D019797:3-Iodobenzylguanidine; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D003627:Data Interpretation, Statistical; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004452:Echocardiography; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging* / Q000294:innervation*; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D007457:Iodine Radioisotopes; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D013902:Radiography, Thoracic; D015635:Radionuclide Ventriculography; D019275:Radiopharmaceuticals; D013318:Stroke Volume; D013564:Sympathetic Nervous System / Q000000981:diagnostic imaging*; D013997:Time Factors; D016277:Ventricular Function, Left
D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D009638:Norepinephrine