title: Creation of mortality risk charts using 123I meta-iodobenzylguanidine heart-to-mediastinum ratio in patients with heart failure: 2- and 5-year risk models.
abstract: OBJECTIVE
  (123)I meta-iodobenzylguanidine (MIBG) imaging has been extensively used for prognostication in patients with chronic heart failure (CHF). The purpose of this study was to create mortality risk charts for short-term (2 years) and long-term (5 years) prediction of cardiac mortality.
  
  
  RESULTS
  Using a pooled database of 1322 CHF patients, multivariate analysis, including (123)I-MIBG late heart-to-mediastinum ratio (HMR), left ventricular ejection fraction (LVEF), and clinical factors, was performed to determine optimal variables for the prediction of 2- and 5-year mortality risk using subsets of the patients (n = 1280 and 933, respectively). Multivariate logistic regression analysis was performed to create risk charts. Cardiac mortality was 10 and 22% for the sub-population of 2- and 5-year analyses. A four-parameter multivariate logistic regression model including age, New York Heart Association (NYHA) functional class, LVEF, and HMR was used. Annualized mortality rate was <1% in patients with NYHA Class I-II and HMR ≥ 2.0, irrespective of age and LVEF. In patients with NYHA Class III-IV, mortality rate was 4-6 times higher for HMR < 1.40 compared with HMR ≥ 2.0 in all LVEF classes. Among the subset of patients with b-type natriuretic peptide (BNP) results (n = 491 and 359 for 2- and 5-year models, respectively), the 5-year model showed incremental value of HMR in addition to BNP.
  
  
  CONCLUSIONS
  Both 2- and 5-year risk prediction models with (123)I-MIBG HMR can be used to identify low-risk as well as high-risk patients, which can be effective for further risk stratification of CHF patients even when BNP is available.
authors.affiliation: Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Japan nakajima@med.kanazawa-u.ac.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nakajima
authors.affiliation: Hakodate Goryoukaku Hospital, Hakodate-City, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Nakata
authors.affiliation: Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
authors.forename: Shinro
authors.initials: S
authors.lastname: Matsuo
authors.affiliation: Diagram Consulting, Kihei, HI, USA.
authors.forename: Arnold F
authors.initials: AF
authors.lastname: Jacobson
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D002423:Cause of Death; D002908:Chronic Disease; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D019797:3-Iodobenzylguanidine
keywords: 123I meta-iodobenzylguanidine; cardiac death; chronic heart failure; prediction model; prognosis; risk chart