Iodine-123-metaiodobenzylguanidine imaging can predict future cardiac events in heart failure patients with preserved ejection fraction.
OBJECTIVE
Iodine-123-metaiodobenzylguanidine ((123)I-MIBG) has been used to assess the function of the cardiac sympathetic nervous system in patients with chronic heart failure (HF). The usefulness of (123)I-MIBG imaging for evaluating patients with heart failure with preserved ejection fraction (HFPEF) has not been established.


METHODS
We performed (123)I-MIBG scintigraphy and echocardiography and measured the plasma brain natriuretic peptide (BNP) levels of 117 consecutive HF patients (64 men, mean age 66 ± 14 years) with a left ventricular ejection fraction (LVEF) of ≥50% who were admitted to our hospital. Patients were divided into 2 groups according to the New York Heart Association (NYHA) functional class.


RESULTS
The (123)I-MIBG delayed heart-to-mediastinum (H/M) ratio was significantly lower, and the washout rate (WR) was higher in patients with HFPEF with advanced NYHA functional class (NYHA functional class I and II vs. III: 1.90 ± 0.34 vs. 1.49 ± 0.32, p < 0.0001; 25.9 ± 13.4 vs. 46.9 ± 16.3%, p < 0.0001, respectively). On the other hand, the (123)I-MIBG WR was not correlated with LVEF and had a weak correlation with plasma BNP levels (R = 0.207, p = 0.0346). Moreover, patients with a high (123)I-MIBG WR showed a poor clinical outcome (p = 0.0033).


CONCLUSIONS
(123)I-MIBG imaging provides independent prognostic information in patients with HFPEF.
Katoh
Shigehiko
S
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, Japan.
Shishido
Tetsuro
T
Kutsuzawa
Daisuke
D
Arimoto
Takanori
T
Netsu
Shunsuke
S
Funayama
Akira
A
Ishino
Mitsunori
M
Niizeki
Takeshi
T
Nishiyama
Satoshi
S
Takahashi
Hiroki
H
Miyashita
Takehiko
T
Miyamoto
Takuya
T
Nitobe
Joji
J
Watanabe
Tetsu
T
Kubota
Isao
I
D019797:3-Iodobenzylguanidine / Q000493:pharmacokinetics; D000368:Aged; D003952:Diagnostic Imaging; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D012306:Risk; D013318:Stroke Volume
D020097:Natriuretic Peptide, Brain; D019797:3-Iodobenzylguanidine