Cardiac sympathetic nerve imaging in patients with heart failure or lethal arrhythmias: risk stratification and assessment of therapeutic interventions

• Published in: International Congress series 2004-03, Vol.1264, p.126-131
• Main Authors: Nakata, Tomoaki, Kyuma, Michifumi, Nagahara, Daigo, Wakabayashi, Takeru, Noda, Ryosuke, Shimamoto, Kazuaki
• Format: Article
• Language: English
• Subjects: Cardiac sympathetic nerve function; Heart failure; Metaiodobenzylguanidine (MIBG); Mortality; Sudden cardiac death
• ISSN: 0531-5131; 1873-6157
• DOI: 10.1016/j.ics.2003.12.052

Cardiac metaiodobenzylguanidine (MIBG) activity level is an independent predictor of survival and has incremental prognostic values in patients with heart failure. We prospectively compared mortality rates of 168 patients with left ventricular (LV) ejection fraction of less than 40% to clarify whether cardiac MIBG activity level was closely related to mortality rate under the treatment with angiotensin-converting enzyme (ACE) inhibitors and/or beta-blockers and whether it enables prediction of the efficacy of treatment. The drug treatment significantly reduced mortality rate at 60 months, and the reduction in mortality risk in patients without a severe MIBG defect (67%) was two-times greater than that in patients with a severe MIBG defect (32%). In other 35 patients in whom implantable cardioverter defibrillator (ICD) had been used, cardiac MIBG activity in combination with degree of heart rate variability, plasma brain natriuretic peptide (BNP) level, or ejection fraction enabled more reliable prediction of increased risk for sudden cardiac death irrespective of other clinical or electrophysiological data. Thus, cardiac MIBG activity level still has powerful prognostic power under the condition of a contemporary pharmacological treatment and is useful for appropriate selection of patients who are at greater risk for cardiac death and for prediction of the effects of aggressive therapeutic strategies.