PMID- 23845574
OWN - NLM
STAT- MEDLINE
DCOM- 20140307
LR  - 20161125
IS  - 1876-7591 (Electronic)
IS  - 1876-7591 (Linking)
VI  - 6
IP  - 7
DP  - 2013 Jul
TI  - A pooled analysis of multicenter cohort studies of (123)I-mIBG imaging of 
      sympathetic innervation for assessment of long-term prognosis in heart failure.
PG  - 772-84
LID - S1936-878X(13)00307-0 [pii]
LID - 10.1016/j.jcmg.2013.02.007 [doi]
AB  - OBJECTIVES: The study objectives were to create a cardiac metaiodobenzylguanidine 
      (mIBG) database using multiple prospective cohort studies and to determine the 
      quantitative iodine-123-labeled mIBG indices for identifying patients with 
      chronic heart failure (HF) at greatest and lowest risk of lethal events. 
      BACKGROUND: Although the prognostic value of cardiac mIBG imaging in patients 
      with HF has been shown, clinical use of this procedure has been limited. It is 
      required to define universally accepted quantitative thresholds for high and low 
      risk that could be used as an aid to therapeutic decision-making using a large 
      cohort database. METHODS: Six prospective HF cohort studies were updated, and the 
      individual datasets were combined for the present patient-level analysis. The 
      database consisted of 1,322 patients with HF followed up for a mean interval of 
      78 months. Heart-to-mediastinum ratio (HMR) and washout rate of cardiac mIBG 
      activity were the primary cardiac innervation markers. The primary outcome 
      analyzed was all-cause death. RESULTS: Lethal events were observed in 326 
      patients, and the population mortality rate was 5.6%, 11.3%, and 19.7% at 1, 2, 
      and 5 years, respectively. Multivariate Cox proportional hazard model analysis 
      for all-cause mortality identified age (p < 0.0001), New York Heart Association 
      (NYHA) functional class (p < 0.0001), late HMR of cardiac mIBG activity (p < 
      0.0001), and left ventricular ejection fraction (LVEF) (p = 0.0029) as 
      significant independent predictors. Analysis of the 512-patient subpopulation 
      with B-type natriuretic peptide (BNP) results showed BNP (p < 0.0001), greater 
      NYHA functional class (p = 0.0002), and late HMR (p = 0.0011) as significant 
      predictors, but LVEF was not. The receiver-operating characteristic-determined 
      threshold of HMR (1.68) identified patients at significantly increased risk in 
      any LVEF category. Survival rates decreased progressively with decreasing HMR, 
      with 5-year all-cause mortality rates >7% annually for HMR <1.25, and <2% 
      annually for HMR >/=1.95. Addition of HMR to clinical information resulted in a 
      significant net reclassification improvement of 0.175 (p < 0.0001). CONCLUSIONS: 
      Pooled analyses of independent cohort studies confirmed the long-term prognostic 
      value of cardiac mIBG uptake in patients with HF independently of other markers, 
      such as NYHA functional class, BNP, and LVEF, and demonstrated that categoric 
      assessments could be used to define meaningful thresholds for lethal event risk.
CI  - Copyright (c) 2013 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Nakata, Tomoaki
AU  - Nakata T
AD  - Second (Cardiology) Department of Internal Medicine, Sapporo Medical University 
      School of Medicine, Sapporo, Hokkaido, Japan. tnakata@sapmed.ac.jp
FAU - Nakajima, Kenichi
AU  - Nakajima K
FAU - Yamashina, Shohei
AU  - Yamashina S
FAU - Yamada, Takahisa
AU  - Yamada T
FAU - Momose, Mitsuru
AU  - Momose M
FAU - Kasama, Shu
AU  - Kasama S
FAU - Matsui, Toshiki
AU  - Matsui T
FAU - Matsuo, Shinro
AU  - Matsuo S
FAU - Travin, Mark I
AU  - Travin MI
FAU - Jacobson, Arnold F
AU  - Jacobson AF
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
RN  - 0 (Biomarkers)
RN  - 0 (Radiopharmaceuticals)
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - 35MRW7B4AD (3-Iodobenzylguanidine)
SB  - IM
MH  - *3-Iodobenzylguanidine
MH  - Aged
MH  - Biomarkers/blood
MH  - Chi-Square Distribution
MH  - Databases as Topic
MH  - Disease Progression
MH  - Evidence-Based Medicine
MH  - Female
MH  - Heart/*diagnostic imaging/*innervation
MH  - Heart Failure/blood/*diagnostic imaging/mortality/physiopathology
MH  - Humans
MH  - Japan
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Multicenter Studies as Topic
MH  - Multivariate Analysis
MH  - Natriuretic Peptide, Brain/blood
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - ROC Curve
MH  - Radionuclide Imaging
MH  - *Radiopharmaceuticals
MH  - Risk Factors
MH  - Stroke Volume
MH  - Sympathetic Nervous System/*diagnostic imaging
MH  - Time Factors
MH  - Ventricular Function, Left
EDAT- 2013/07/13 06:00
MHDA- 2014/03/08 06:00
CRDT- 2013/07/13 06:00
PHST- 2012/07/17 00:00 [received]
PHST- 2013/01/28 00:00 [revised]
PHST- 2013/02/12 00:00 [accepted]
PHST- 2013/07/13 06:00 [entrez]
PHST- 2013/07/13 06:00 [pubmed]
PHST- 2014/03/08 06:00 [medline]
AID - S1936-878X(13)00307-0 [pii]
AID - 10.1016/j.jcmg.2013.02.007 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2013 Jul;6(7):772-84. doi: 10.1016/j.jcmg.2013.02.007.