Cardiac 123 I-MIBG imaging and clinical variables in risk stratification in patients with heart failure treated with beta blockers.
Both myocardial m-[123I]iodobenzylguanidine (123I-MIBG) uptake and plasma norepinephrine are markers of sympathetic activation in heart failure and have been shown to portend a poorer prognosis. However, these observations were noted before treatment with beta blockers became part of standard clinical practice. Fifty-eight patients with chronic heart failure (New York Heart Association functional class II and III, ejection fraction <35%; 53% ischaemic cardiomyopathy) were prospectively studied with a mean follow-up of 36 months. During the observational period, 17 patients (29.3%) had a predefined event (death and heart transplantation). All prognostic parameters were obtained before beta blocker therapy was initiated. In both uni- and multivariate analysis, the heart-mediastinum ratio of 123I-MIBG uptake did not correlate with cardiovascular mortality. In the multivariate Cox regression analysis, plasma norepinephrine, peak oxygen consumption, end-diastolic volume as measured by echocardiography and exercise performance during bicycling and walking had prognostic significance in patients with heart failure treated with beta blockers in addition to angiotensin-converting enzyme inhibitors.
de Milliano
P A R
PA
Department of Cardiology, Ziekenhuis Hilversum, Netherlands. pardemilliano@wxs.nl
Tijssen
J G P
JG
van Eck-Smit
B L F
BL
Lie
K I
KI
D019797:3-Iodobenzylguanidine / Q000493:pharmacokinetics; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage; D009638:Norepinephrine / Q000097:blood; D010101:Oxygen Consumption / Q000502:physiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015635:Radionuclide Ventriculography / Q000379:methods; D019275:Radiopharmaceuticals; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume
D000319:Adrenergic beta-Antagonists; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D008790:Metoprolol; D009638:Norepinephrine