title: Usefulness of cardiac meta-iodobenzylguanidine imaging to identify patients with chronic heart failure and left ventricular ejection fraction <35% at low risk for sudden cardiac death.
abstract: Patients with chronic heart failure (CHF) at risk of sudden cardiac death (SCD) are often treated with implantable cardiac defibrillators (ICDs). However, current criteria for device use that is based largely on left ventricular ejection fraction (LVEF) lead to many patients receiving ICDs that never deliver therapy. It is of clinical significance to identify patients who do not require ICDs. Although cardiac I-123 meta-iodobenzylguanidine (MIBG) imaging provides prognostic information about CHF, whether it can identify patients with CHF who do not require an ICD remains unclear. We studied 81 patients with CHF and LVEF <35%, assessed by cardiac MIBG imaging at enrollment. The heart-to-mediastinal ratio (H/M) in delayed images and washout rates were divided into 6 grades from 0 to 5, according to the degree of deviation from control values. The study patients were classified into 3 groups: low (1 to 4), intermediate (5 to 7), and high (8 to 10), according to the MIBG scores defined as the sum of the H/M and washout rate scores. Sixteen patients died of SCD during a follow-up period. Patients with low MIBG score had a significantly lower risk of SCD than those with intermediate and high scores (low [n = 19], 0%; intermediate [n = 37], 19%; high [n = 25], 36%; p = 0.001). The positive predictive value of low MIBG score for identifying patients without SCD was 100%. In conclusion, the MIBG score can identify patients with CHF and LVEF <35% who have low risk of developing SCD.
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Tsutomu
authors: T
authors: Kawai
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan. Electronic address: takaymda@nike.eonet.ne.jp.
authors: Takahisa
authors: T
authors: Yamada
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Shunsuke
authors: S
authors: Tamaki
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Takashi
authors: T
authors: Morita
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Yoshio
authors: Y
authors: Furukawa
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Yusuke
authors: Y
authors: Iwasaki
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Masato
authors: M
authors: Kawasaki
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Atsushi
authors: A
authors: Kikuchi
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Takumi
authors: T
authors: Kondo
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Satoshi
authors: S
authors: Takahashi
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Masashi
authors: M
authors: Ishimi
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Hideyuki
authors: H
authors: Hakui
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Tatsuhisa
authors: T
authors: Ozaki
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Yoshihiro
authors: Y
authors: Sato
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Masahiro
authors: M
authors: Seo
authors: Division of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Yasushi
authors: Y
authors: Sakata
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors: Masatake
authors: M
authors: Fukunami
mesh_terms: D019797:3-Iodobenzylguanidine; D002908:Chronic Disease; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012306:Risk; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine