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Prognostic Value of Cardiac Metaiodobenzylguanidine Imaging in Patients with Heart Failure

Service de Cardiologie et de Chirurgie Cardio-vasculaire, Centre Hospitalo-Universitaire Henri Mondor, Créteil
Service de Cardiologie, Centre Hospitalo-Universitaire de Cochin, Paris
Centre Médico-Chirurgical de Bligny, Bligny
Service Hospitalier Frédéric Joliot, Commissariat à l'Energie Atomique, Orsay, France

Correspondence: For reprints contact: Pascal Merlet, MD, Service Hospitalier Frédéric Joliot, Commissariat à I'Energie Atomique, 4 place du Général Leclerc, 91401 Orsay, France.

ABSTRACT

The prognostic value of ¹²³I-metaiodobenzylguanidine (MIBG) imaging was compared with that of other noninvasive cardiac imaging indices in ninety patients (mean age = 52 ± 7 yr) suffering from either ischemic (n = 24) or idiopathic (n = 66) cardiomyopathy. Patients had different measurements taken: cardiac MIBG uptake, radionuclide left ventricular ejection fraction, x-ray cardiothoracic ratio and echographic M-Mode data. Cardiac MIBG uptake was assessed as the heart-to-mediastinum activity ratio measured on the chest anterior view image obtained 4 hr after intravenous injection. The patients then had follow-up for 1–27 mo, at which time 10 patients had transplants, 22 had died and 58 were still alive. Data from patients with transplants were not used in the analysis, in which multivariate stepwise regression discriminant analysis showed that cardiac MIBG uptake was more potent to predict survival than other indices: H/M (p < 0.0001), x-ray cardiothoracic ratio (p = 0.0017), echographic end-diastolic diameter (p = 0.0264) and radionuclide left ventricular ejection fraction (p = 0.0301). Moreover, multivariate life table analysis showed that cardiac MIBG uptake was also the best predictor for life duration: H/M (p = 0.0001), radionuclide left ventricular ejection fraction (p = 0.0098) and x-ray cardiothoracic ratio (p = 0.0139); echographic data were not useful. Thus, cardiac MIBG imaging may be helpful for heart transplantation decision making in patients with heart failure.