title: Usefulness of Cardiac MetaIodobenzylguanidine Imaging to Improve Prognostic Power of the Model for End-Stage Liver Disease Scoring System in Patients With Mild-to-Moderate Chronic Heart Failure.
abstract: Liver dysfunction has a prognostic impact on the outcomes of patients with advanced heart failure (HF). The model for end-stage liver disease (MELD) score is a robust system for rating liver dysfunction, and a high score has been shown to be associated with a poor prognosis in ambulatory patients with HF. In addition, cardiac metaiodobenzylguanidine (MIBG) imaging provides prognostic information in patients with chronic HF (CHF). However, the long-term predictive value of combining the MELD score and cardiac MIBG imaging in patients with CHF has not been elucidated. To prospectively investigate whether cardiac MIBG imaging provides additional prognostic value to the MELD score in patients with mild-to-moderate CHF, we studied 109 CHF outpatients (New York Heart Association: 2.0 ± 0.6) with left ventricular ejection fraction <40%. At enrollment, an MELD score was obtained, and the heart-to-mediastinal ratio on delayed imaging and MIBG washout rate (WR) were measured using cardiac MIBG scintigraphy. During a follow-up period of 7.5 ± 4.2 years, 36 of 109 patients experienced cardiac death (CD). On multivariate Cox analysis, MELD score and WR were significantly independently associated with CD, although heart-to-mediastinal ratio showed an association with CD only on univariate Cox analysis. Patients with abnormal WR (>27%) had a significantly greater risk of CD than those with normal WR in both those with high MELD scores (≥10; hazard ratio 4.0 [1.2 to 13.6]) and with low MELD scores (<10; hazard ratio 6.4 [1.7 to 23.2]). In conclusion, cardiac MIBG imaging would provide additional prognostic information to the MELD score in patients with mild-to-moderate CHF.
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hakui
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan. Electronic address: takaymda@nike.eonet.ne.jp.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Tamaki
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Morita
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Furukawa
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Iwasaki
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Kawasaki
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kikuchi
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Ishimi
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Seo
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Tatsuhisa
authors.initials: T
authors.lastname: Ozaki
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Iyo
authors.initials: I
authors.lastname: Ikeda
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Fukuhara
authors.affiliation: Division of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
authors.affiliation: Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
authors.forename: Masatake
authors.initials: M
authors.lastname: Fukunami
mesh_terms: D019797:3-Iodobenzylguanidine / Q000494:pharmacology*; D058625:End Stage Liver Disease / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging / Q000379:methods*; D019275:Radiopharmaceuticals / Q000494:pharmacology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine