Prediction of all-cause death using C-11 hydroxyephedrine PET in patients with left ventricular dysfunction

Objectives Although C-11 hydroxyephedrine (HED) PET has been used to assess cardiac sympathetic innervation in various disease conditions, data on its prognostic value are limited. In recent years, all-cause death is increasingly utilized as an unbiased end point in clinical trials. The aim of this study was to determine whether HED PET can be used to predict all-cause death in patients with left ventricular (LV) dysfunction.

Methods Fifty-one patients (mean LVEF, 43±15%) with LV dysfunction (36 ischemic and 15 non-ischemic heart disease) underwent HED PET. Global LV myocardial retention was calculated for HED PET as a measure of cardiac sympathetic neuronal integrity. Statistical analysis was performed using Cox proportional hazards regression or log-rank test.

Results Eight deaths (4 cardiac and 4 non-cardiac death) occurred during a mean follow-up period of 27±24 months. The patients with death were associated with significantly lower HED retention (6.9±1.1 vs 8.9±1.4, p=0.03) than those without death. The age-corrected hazard ratio for continuous HED retention over entire range was 236.4 (p=0.008). When the patients were divided into the high (≥9) and low (<9) HED retention groups, the low HED retention group was associated with significantly poorer survival than the high HED retention group (p=0.014) (Figure).

Conclusions Our results indicate that low HED retention measured by PET is a marker of poor survival in patients with LV dysfunction.

Research Support This work was supported by Ishikawa prefectural government.