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Long-term prognostic stratification by a combination of 123I-metaiodobenzylguanidine scintigraphy and ejection fraction in dilated cardiomyopathy

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Abstract

Objective

123I-metaiodobenzylguanidine (MIBG) scintigraphy is a useful tool for predicting the prognosis in patients with congestive heart failure; however, little is known regarding long-term prognostic evaluations. The aim of this study was to evaluate long-term prognosis in a roughly 10-year period, in dilated cardiomyopathy (DCM) by MIBG imaging, compared to other conventional functional parameters.

Methods

Eighty-six DCM patients (50 ± 14 years of age, 57 males) underwent MIBG imaging, at 15 min and 4 h after tracer injection, from which the delayed heart to mediastinum ratio (H/M) and washout rate (WR) were obtained. The left ventricular ejection fraction (EF) and end-diastolic diameter (LVDd) were also measured by echocardiogram. All patients were followed up for 8–14 years, and the death event was investigated.

Results

Kaplan–Meier curves revealed a poor prognosis only in the group above the third quartile of WR (=50%) (10-year prognosis, 35%); however, there were no statistically significant differences in prognosis among the other 3 groups (10-year prognosis, 75–84%). A Cox hazard univariate analysis selected WR (p = 0.0004), H/M (p < 0.0001), EF (p = 0.0024), and LVDd (p = 0.0189) as significant prognostic indicators. Multivariate analysis revealed the H/M (p = 0.0023) and EF (p = 0.024) to be an independent prognostic predictor. The 10-year prognosis of patients with both WR < 50% and EF > 30%; WR < 50% and EF < 30%; and both WR > 50% and EF < 30% were 89, 71, and 33%, respectively. These three groups were well stratified, significantly (log-rank test: χ 2 = 30.0, p < 0.0001). However, even patients with WR ≥ 50% had few death events after 3 years following MIBG imaging.

Conclusions

The MIBG parameter, delayed H/M or WR combined with the EF is a useful tool for the prediction of a long-term prognosis in DCM, which is superior to MIBG parameters alone. However, patients with WR > 50% but no event in a 3-year follow-up period should undergo an additional MIBG imaging for prognostic prediction.

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Authors and Affiliations

  1. Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Mitsuru Momose, Chisato Kondo & Shuji Sakai

  2. Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan

    Dai Okayama, Hitoshi Nagamatsu & Nobuhisa Hagiwara

Authors
  1. Mitsuru Momose
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  2. Dai Okayama
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  3. Hitoshi Nagamatsu
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  4. Chisato Kondo
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  5. Nobuhisa Hagiwara
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  6. Shuji Sakai
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Correspondence to Mitsuru Momose.

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Momose, M., Okayama, D., Nagamatsu, H. et al. Long-term prognostic stratification by a combination of 123I-metaiodobenzylguanidine scintigraphy and ejection fraction in dilated cardiomyopathy. Ann Nucl Med 25, 419–424 (2011). https://doi.org/10.1007/s12149-011-0479-x

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  • DOI: https://doi.org/10.1007/s12149-011-0479-x

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