Indium-111 monoclonal antimyosin cardiac scintigraphy in men with idiopathic dilated cardiomyopathy.
This study examined the prognostic value and the evolution of the heart-to-lung ratio of monoclonal antimyosin antibody (MAA) uptake in patients with a diagnosis of idiopathic dilated cardiomyopathy (IDC). Uptake of indium-111-labeled MAA occurs when the myocytes become irreversibly damaged. The study included 29 men with IDC followed up for 3 years. The diagnosis was verified by endomyocardial biopsy in all patients. Patients who survived beyond 1 year were restudied. Baseline heart-to-lung ratio of MAA was 1.74+/-0.22. Multivariate Cox regression analysis revealed that MAA and New York Heart Association class were independent predictors of late mortality, with a hazard ratio of 4.4 (95% confidence interval 1.1 to 17.9, p = 0.036) and 7.5 (95% confidence interval 2.0 to 28.4, p = 0.003), respectively, when heart-to-lung ratio of MAA uptake was > 1.74 and New York Heart Association class was >11. When these patients were divided into those with chronic IDC (group I [n = 19]) and those with subacute IDC (group II [n = 10]), baseline heart-to-lung ratio was 1.7+/-0.2 and 1.86+/-0.25, respectively (p = NS). In the surviving patients, on restudy, the heart-to-lung ratio of MAA uptake was unchanged in group I (1.64+/-0.20, p = NS), but had decreased to the level of group I (1.66+/-0.21 [p = 0.008]) in group II. Thus, men with IDC and a high heart-to-lung ratio of MAA uptake have a worse long-term prognosis than patients with a lower ratio. The heart-to-lung ratio of MAA decreases comparably over time in subacute IDC and remains stable in chronic IDC.
Nanas
J N
JN
University of Athens, School of Medicine, Department of Clinical Therapeutics, Alexandra Hospital, Greece.
Margari
Z J
ZJ
Lekakis
J P
JP
Alexopoulos
G E
GE
Prassopoulos
V
V
Agapitos
E V
EV
Toumanidis
S T
ST
Anastasiou-Nana
M I
MI
Kostamis
P
P
Stamatelopoulos
S F
SF
D000328:Adult; D000911:Antibodies, Monoclonal / Q000097:blood; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000276:immunology / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007205:Indium Radioisotopes; D008297:Male; D008875:Middle Aged; D009218:Myosins / Q000276:immunology; D011379:Prognosis; D011877:Radionuclide Imaging; D012307:Risk Factors; D012720:Severity of Illness Index; D016277:Ventricular Function, Left
D000911:Antibodies, Monoclonal; D007205:Indium Radioisotopes; D009218:Myosins