title: Long-term prognostic stratification by a combination of (123)I-metaiodobenzylguanidine scintigraphy and ejection fraction in dilated cardiomyopathy.
abstract: OBJECTIVE
  (123)I-metaiodobenzylguanidine (MIBG) scintigraphy is a useful tool for predicting the prognosis in patients with congestive heart failure; however, little is known regarding long-term prognostic evaluations. The aim of this study was to evaluate long-term prognosis in a roughly 10-year period, in dilated cardiomyopathy (DCM) by MIBG imaging, compared to other conventional functional parameters.
  
  
  METHODS
  Eighty-six DCM patients (50 ± 14 years of age, 57 males) underwent MIBG imaging, at 15 min and 4 h after tracer injection, from which the delayed heart to mediastinum ratio (H/M) and washout rate (WR) were obtained. The left ventricular ejection fraction (EF) and end-diastolic diameter (LVDd) were also measured by echocardiogram. All patients were followed up for 8-14 years, and the death event was investigated.
  
  
  RESULTS
  Kaplan-Meier curves revealed a poor prognosis only in the group above the third quartile of WR (=50%) (10-year prognosis, 35%); however, there were no statistically significant differences in prognosis among the other 3 groups (10-year prognosis, 75-84%). A Cox hazard univariate analysis selected WR (p = 0.0004), H/M (p < 0.0001), EF (p = 0.0024), and LVDd (p = 0.0189) as significant prognostic indicators. Multivariate analysis revealed the H/M (p = 0.0023) and EF (p = 0.024) to be an independent prognostic predictor. The 10-year prognosis of patients with both WR < 50% and EF > 30%; WR < 50% and EF < 30%; and both WR > 50% and EF < 30% were 89, 71, and 33%, respectively. These three groups were well stratified, significantly (log-rank test: χ (2) = 30.0, p < 0.0001). However, even patients with WR ≥ 50% had few death events after 3 years following MIBG imaging.
  
  
  CONCLUSIONS
  The MIBG parameter, delayed H/M or WR combined with the EF is a useful tool for the prediction of a long-term prognosis in DCM, which is superior to MIBG parameters alone. However, patients with WR > 50% but no event in a 3-year follow-up period should undergo an additional MIBG imaging for prognostic prediction.
authors: Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan. mmomose@rad.twmu.ac.jp
authors: Mitsuru
authors: M
authors: Momose
authors: Dai
authors: D
authors: Okayama
authors: Hitoshi
authors: H
authors: Nagamatsu
authors: Chisato
authors: C
authors: Kondo
authors: Nobuhisa
authors: N
authors: Hagiwara
authors: Shuji
authors: S
authors: Sakai
mesh_terms: D019797:3-Iodobenzylguanidine; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011877:Radionuclide Imaging; D013318:Stroke Volume; D016019:Survival Analysis; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging
chemical_list: D019797:3-Iodobenzylguanidine