title: Cardiac sympathetic denervation and ongoing myocardial damage for prognosis in early stages of heart failure.
abstract: BACKGROUND
  Iodine-123-metaiodobenzylguanidine ((123)I-MIBG) can assess cardiac sympathetic nervous function. Heart-type fatty acid binding protein (H-FABP) has been used as a marker of ongoing myocardial damage. The prognostic value of combination (123)I-MIBG imaging and H-FABP in heart failure is unknown.
  
  
  RESULTS
  We prospectively enrolled consecutive 104 patients with heart failure in whom we quantified (123)I-MIBG scintigraphy, simultaneously measured serum H-FABP and plasma brain natriuretic peptide (BNP) levels, and analyzed clinical outcomes. The multivariate Cox regression analysis revealed that augmented H-FABP level and decreased heart to mediastinum ratio of (123)I-MIBG at 240 minutes (delayed H/M ratio), but not BNP, were the independent predictors for cardiac events. The cutoff values for H-FABP and delayed H/M ratio were determined from the receiver operating characteristic curves as 5.2 ng/mL for H-FABP and 1.73 for delayed H/M ratio. The cardiac event rate was markedly higher in patients with both H-FABP and delayed H/M ratio of (123)I-MIBG was abnormal. Conversely, no cardiac events occurred in patients with both H-FABP level and delayed H/M ratio were normal.
  
  
  CONCLUSIONS
  H-FABP adds independent prognostic information to delayed H/M ratio of (123)I-MIBG imaging, and the combination of these approaches may improve the accuracy of prognostic determination in heart failure.
authors.affiliation: First Department of Internal Medicine, Yamagata University School of Medicine, Yamagata, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Arimoto
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Takeishi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Niizeki
authors.forename: Naoki
authors.initials: N
authors.lastname: Nozaki
authors.forename: Osamu
authors.initials: O
authors.lastname: Hirono
authors.forename: Tetsu
authors.initials: T
authors.lastname: Watanabe
authors.forename: Joji
authors.initials: J
authors.lastname: Nitobe
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Tsunoda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Yo
authors.initials: Y
authors.lastname: Koyama
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Kitahara
authors.forename: Akio
authors.initials: A
authors.lastname: Okada
authors.forename: Kazuei
authors.initials: K
authors.lastname: Takahashi
authors.forename: Isao
authors.initials: I
authors.lastname: Kubota
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D006321:Heart / Q000294:innervation*; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013564:Sympathetic Nervous System / Q000503:physiopathology
chemical_list: C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D019275:Radiopharmaceuticals; D020097:Natriuretic Peptide, Brain; D019797:3-Iodobenzylguanidine