Abstract 10510: Prognostic Value of the Combination of Cardiac MIBG Imaging and Serum Cholinesterase Level in Patients Admitted for Acute Decompensated Heart Failure

Abstract

Backgrounds: Cardiac MIBG imaging provides prognostic information in patients with acute decompensated heart failure (ADHF). On the other hand, serum cholinesterase (CHE) level, which reflect various factors such as hepatic function, inflammation and nutritional status, has been reported to be associated with poor outcome in ADHF patients. However, there is no information available on the prognostic value of the combination of cardiac MIBG imaging and CHE level in patients admitted for ADHF. Methods: We studied 579 consecutive patients admitted for ADHF. Cardiac MIBG imaging, echocardiography and venous blood sampling were performed just before discharge. The cardiac MIBG heart-to-mediastinum ratio (late HMR) was measured on the chest anterior view images obtained at 200 min after the isotope injection. The primary endpoint was cardiac event (CE) defined as unplanned heart failure hospitalization and cardiac death. Results: During a follow up period of 2.8±0.9 years, 196 patients reached the primary endpoint. On multivariate Cox analysis, late-HMR (p<0.0001, HR 1.82 [1.34-2.47) and serum CHE level (p=0.047, HR 1.40 [1.01-1.94]) were significantly associated with CE after adjustment for age, sex, left ventricular ejection fraction, history of hypertension, diabetes mellitus, hemoglobin, blood urea nitrogen and albumin. Kaplan-Meier survival curve analysis demonstrated that patients with both low serum CHE level (<217 U/L=median value) and late-HMR (<1.66=median value) had a significantly increased risk of CE in than those either or none of them. Conclusion: The combination of cardiac MIBG imaging and serum CHE level would be useful for stratifying ADHF patients at risk for cardiac events.