title: Risk stratification of patients with chronic heart failure using cardiac iodine-123 metaiodobenzylguanidine imaging: incremental prognostic value over right ventricular ejection fraction.
abstract: OBJECTIVE
  Right ventricular (RV) systolic dysfunction has been shown to be an independent predictor of clinical outcome in patients with chronic heart failure (CHF), and cardiac metaiodobenzylguanidine (MIBG) imaging also provides prognostic information. We aimed to evaluate the long-term predictive value of combining RV systolic dysfunction and abnormal findings of cardiac MIBG imaging on outcome in CHF patients.
  
  
  RESULTS
  We enrolled 63 CHF outpatients with left ventricular ejection fraction (EF) <40% in a prospective cohort study. At entry, RVEF was measured by radionuclide angiography. Furthermore, cardiac MIBG imaging was performed, and the cardiac MIBG washout rate (WR) was calculated. Reduced RVEF was defined as ≤37%, and abnormal WR was defined as >27%. The study endpoint was unplanned hospitalization for worsening heart failure (WHF) and cardiac death. During a follow-up period of 8.9 ± 4.3 years, 19 of 63 patients had unplanned hospitalization for WHF, and 19 of 63 patients had cardiac death. In multivariate analysis, both WR and RVEF were independent predictors of unplanned WHF hospitalization, while WR was also an independent predictor of cardiac death. A risk-stratification model based on independent predictors of unplanned WHF hospitalization separated the patients into those with low (absence of the predictors), intermediate (one of the predictors), and high (two or more of the predictors) risk of unplanned WHF hospitalization (P< 0.0001) or cardiac death (P= 0.0113).
  
  
  CONCLUSIONS
  Cardiac MIBG imaging provides incremental value when it is used along with RV systolic dysfunction to predict clinical outcome in patients with CHF.
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: Takahisa
authors.initials: T
authors.lastname: Yamada
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: Tsutomu
authors.initials: T
authors.lastname: Kawai
authors.affiliation: Division of Cardiology Osaka General Medical Center Osaka Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
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: Hideyuki
authors.initials: H
authors.lastname: Hakui
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: 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 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
keywords: Cardiac metaiodobenzylguanidine imaging; Chronic heart failure; Nuclear cardiology; Prognosis; Reduced left ventricular ejection fraction; Right ventricular systolic function