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Fédération de Cardiologie et de Chirurgie Cardio-vasculaire, Center Hospitalo-Universitaire Henri Mondor, Créteil
Service Hospitalier Frédéric Joliot, Département de Recherche Médicale, CEA, Orsay, France
Correspondence: For correspondence or reprints contact: Pascal Merlet, MD, Service Hospitalier Frédéric Joliot, Commissariat à l'Energie Atomique, 4 place du Général Leclerc, 91401 Orsay, France.
ABSTRACT
Alterations of cardiac sympathetic innervation are likely to contribute to fatal outcomes in patients with heart failure. These alterations can be evaluated noninvasively by 123l-metaiodobenzylguanidine (MIBG) imaging. Methods: The hypothesis that impaired cardiac sympathetic innervation, as assessed using MIBG imaging, is related to adverse outcomes was tested in 112 patients with heart failure resulting from idiopathic cardiomyopathy. Main inclusion criteria were New York Heart Association classes II–IV and radionuclide left ventricular ejection fraction (LVEF) < 40%. Patients were assessed for cardiac MIBG uptake, circulating norepinephrine concentration, LVEF, peak Vo2, x-ray cardiothoracic ratio, M-mode echographic end-diastolic diameter and right-sided heart catheterization parameters. Results: During a mean follow-up of 27 ± 20 mo, 19 patients had transplants, 25 died of cardiac death (8 sudden deaths), 2 died of noncardiac death and 66 survived without transplantation. The only independent predictors for mortality were low MIBG uptake (P < 0.001) and LVEF (P = 0.02) when using multivariate discriminant analysis. Moreover, MIBG uptake (P < 0.001) and circulating norepinephrine concentration (P = 0.001) were the only independent predictors for life duration when using multivariate life table analysis. Conclusion: Impaired cardiac adrenergic innervation as assessed by MIBG imaging is strongly related to mortality. MIBG imaging may help risk stratify patients with heart failure resulting from idiopathic dilated cardiomyopathy.
Key Words: heart failure • idiopathic cardiomyopathy • prognosis • autonomic nervous system • norepinephrine
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