title: For what endpoint does myocardial 123I-MIBG scintigraphy have the greatest prognostic value in patients with chronic heart failure? Results of a pooled individual patient data meta-analysis.
abstract: OBJECTIVE
  The purpose of this study was to determine the most appropriate prognostic endpoint for myocardial (123)I-metaiodobenzylguanidine (MIBG) scintigraphy in patients with chronic heart failure (CHF) based on aggregate results from multiple studies published in the past decade.
  
  
  RESULTS
  Original individual late (3-5 h) heart/mediastinum (H/M) ratio data of 636 CHF patients were retrieved from six studies from Europe and the USA. All-cause mortality, cardiac mortality, arrhythmic events, and heart transplantation were investigated to determine which provided the strongest prognostic significance for the MIBG imaging data. The majority of patients was male (78%), had a decreased left ventricular ejection fraction (31.1 ± 12.5%), and a mean late H/M of 1.67 ± 0.47. During follow-up (mean 36.9 ± 20.1 months), there were 83 deaths, 67 cardiac deaths, 33 arrhythmic events, and 56 heart transplants. In univariate regression analysis, late H/M was a significant predictor of all event categories, but lowest hazard ratios (HRs) were for the composite endpoint of any event (HR = 0.30, 95% CI 0.19-0.46), all-cause (HR = 0.29, 95% CI 0.16-0.53), and cardiac mortality (HR = 0.28, 95% CI 0.14-0.55). In multivariate analysis, late H/M was an independent predictor for all event categories, except for arrhythmias.
  
  
  CONCLUSIONS
  This pooled individual patient data meta-analysis showed that, in CHF patients, the late H/M ratio is not only useful as a dichotomous predictor of events (high vs. low risk), but also has prognostic implication over the full range of the outcome value for all event categories except arrhythmias.
authors.affiliation: Department of Nuclear Medicine, Room F2-238, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands Department of Cardiology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands.
authors.forename: Derk O
authors.initials: DO
authors.lastname: Verschure
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Veltman
authors.affiliation: Department of Nuclear Medicine, Service Commun Investigations chez l'Homme, GIP Cyceron, Caen, Francec.
authors.forename: Alain
authors.initials: A
authors.lastname: Manrique
authors.affiliation: Cardiology Centres the Netherlands, Amsterdam, The Netherlands.
authors.forename: G Aernout
authors.initials: GA
authors.lastname: Somsen
authors.affiliation: Department of Nuclear Medicine, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Koutelou
authors.affiliation: Department of Nuclear Medicine, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Katsikis
authors.affiliation: Department of Nuclear Medicine, CHU Côte de Nacre, Caen, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Agostini
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Myron C
authors.initials: MC
authors.lastname: Gerson
authors.affiliation: Department of Nuclear Medicine, Room F2-238, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Berthe L F
authors.initials: BL
authors.lastname: van Eck-Smit
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arthur J H A
authors.initials: AJ
authors.lastname: Scholte
authors.affiliation: GE Healthcare, Princeton, NJ, USA.
authors.forename: Arnold F
authors.initials: AF
authors.lastname: Jacobson
authors.affiliation: Department of Nuclear Medicine, Room F2-238, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands h.j.verberne@amc.uva.nl.
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Verberne
mesh_terms: D019797:3-Iodobenzylguanidine; D002423:Cause of Death; D002908:Chronic Disease; D023381:Endpoint Determination; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine
keywords: Cardiac sympathetic nerve function; Heart failure; Metaiodobenzylguanidine; Pooled analysis; Prognosis