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Assessment of Underlying Etiology and Cardiac Sympathetic Innervation to Identify Patients at High Risk of Cardiac Death

Second Department of Internal Medicine (Cardiology), Sapporo Medical University School of Medicine, Sapporo, Japan; and Department of Nuclear Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York

View larger version (90K): [in a new window]   FIGURE 1. Planar early and late 123I-MIBG and 201Tl images of 2 typical patients, 72-y-old man with ISM and sudden cardiac death (A) and 65-y-old woman with ICM and death from heart failure (B). Both early and late cardiac 123I-MIBG uptakes are tremendously reduced in well-perfused hearts; in particular, late H/M was <1.5 in both patients.

View larger version (39K): [in a new window]   FIGURE 2. Kaplan–Meier survival curves produced by identified cutoff values of late H/M in patients with ISM (A) and ICM (B). In both ISM and ICM groups, patients with late H/M < 1.82, as identified by overall analysis, show significantly lower survival rates than those with late H/M 1.82. Furthermore, when patients with LVEF < 40% are considered, ischemic patients with late H/M < 1.50 and idiopathic patients with late H/M < 2.02 show significantly lower survival rates than each counterpart.

View larger version (31K): [in a new window]   FIGURE 3. Annual rate of cardiac death when each group was divided into 4 subgroups based on LVEF of 40% and on identified thresholds of 123I-MIBG activity. For LVEF of <40% and late H/M less than identified thresholds (1.5 for ischemic and 2.02 for idiopathic), annual rates of cardiac death are greatest, 18.2%/y for ischemic group and 11.9%/y for idiopathic group, when subgroup with LVEF of 40% or more and late H/M > 2.02 are excluded because of small number of patients (n = 3).