PMID- 9869480
OWN - NLM
STAT- MEDLINE
DCOM- 19990303
LR  - 20230317
IS  - 1071-3581 (Print)
IS  - 1071-3581 (Linking)
VI  - 5
IP  - 6
DP  - 1998 Nov-Dec
TI  - Cardiac death prediction and impaired cardiac sympathetic innervation assessed by 
      MIBG in patients with failing and nonfailing hearts.
PG  - 579-90
AB  - BACKGROUND: Although cardiac sympathetic nerve dysfunction is related to poor 
      clinical outcome, a critical sympathetic dysfunction level for predicting cardiac 
      death is still unclear. The current study was designed to investigate which 
      indices derived from metaiodobenzylguanidine (MIBG) imaging have prognostic value 
      compared with clinical and cardiac function variables, and to determine the 
      threshold of cardiac MIBG activity for identifying patients likely to suffer 
      cardiac death in both failing and nonfailing hearts. METHODS AND RESULTS: 
      Myocardial I-123-MIBG activity was quantified as a heart-to-mediastinum ratio in 
      414 consecutive patients, 173 (42%) of whom had symptomatic heart failure. After 
      cardiac function measurements, patients were followed up with an end-point of 
      cardiac or noncardiac death. During a mean follow-up period of 22 months, 37 
      cardiac deaths occurred: 23 resulted from heart failure, 9 were sudden cardiac 
      deaths, and 5 were fatal myocardial infarctions. Multivariate analysis using the 
      Wald chi2 and the Cox proportional hazard model revealed that late 
      heart-to-mediastinum ratio, the use of nitrates, early heart-to-mediastinum 
      ratio, and left ventricular ejection fraction were independent predictors of 
      cardiac death; late heart-to-mediastinum ratio, New York Heart Association (NYHA) 
      class, the presence of previous myocardial infarction, and age were independent 
      predictors of heart failure and sudden cardiac death. Late heart-to-mediastinum 
      ratio was the most powerful predictor of overall cardiac death among the 
      variables. The Kaplan-Meier analysis showed that a late heart-to-mediastinum 
      ratio of 1.74 or less, age greater than 60 years, the presence of myocardial 
      infarction, and NYHA functional class 3 or 4 strongly indicated poor clinical 
      outcomes. Furthermore, the more powerful incremental prognostic values were 
      obtained by using MIBG imaging in combination with conventional clinical 
      variables. CONCLUSIONS: Impaired cardiac sympathetic innervation assessed by MIBG 
      activity has the greatest potential for predicting cardiac death and may be 
      useful for identifying a threshold level for selecting patients at risk for death 
      by heart failure, sudden cardiac death, and fatal myocardial infarction.
FAU - Nakata, T
AU  - Nakata T
AD  - Second Department of Internal Medicine, Sapporo Medical University School of 
      Medicine, Japan. tnakata@sapmed.ac.jp
FAU - Miyamoto, K
AU  - Miyamoto K
FAU - Doi, A
AU  - Doi A
FAU - Sasao, H
AU  - Sasao H
FAU - Wakabayashi, T
AU  - Wakabayashi T
FAU - Kobayashi, H
AU  - Kobayashi H
FAU - Tsuchihashi, K
AU  - Tsuchihashi K
FAU - Shimamoto, K
AU  - Shimamoto K
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Nucl Cardiol
JT  - Journal of nuclear cardiology : official publication of the American Society of 
      Nuclear Cardiology
JID - 9423534
RN  - 0 (Iodine Radioisotopes)
RN  - 0 (Radiopharmaceuticals)
RN  - 35MRW7B4AD (3-Iodobenzylguanidine)
SB  - IM
MH  - *3-Iodobenzylguanidine
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiac Output, Low/*diagnostic imaging/mortality/physiopathology
MH  - Confidence Intervals
MH  - Death, Sudden, Cardiac
MH  - Female
MH  - Heart/diagnostic imaging/*innervation
MH  - Humans
MH  - Iodine Radioisotopes
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Prognosis
MH  - *Radiopharmaceuticals
MH  - Risk Factors
MH  - Stroke Volume
MH  - Survival Rate
MH  - Sympathetic Nervous System/*physiopathology
MH  - Tomography, Emission-Computed, Single-Photon
EDAT- 1998/12/30 00:00
MHDA- 1998/12/30 00:01
CRDT- 1998/12/30 00:00
PHST- 1998/12/30 00:00 [pubmed]
PHST- 1998/12/30 00:01 [medline]
PHST- 1998/12/30 00:00 [entrez]
AID - S1071-3581(98)90112-X [pii]
AID - 10.1016/s1071-3581(98)90112-x [doi]
PST - ppublish
SO  - J Nucl Cardiol. 1998 Nov-Dec;5(6):579-90. doi: 10.1016/s1071-3581(98)90112-x.