Abstract 17895: Complementary Prognostic Value of Cardiac Metaiodobenzylguanidine Imaging and Diastolic Wall Strain in Patients With Preserved Left Ventricular Ejection Fraction Admitted for Acute Decompensated Heart Failure

Abstract

Introduction: Cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging has been reported to provide prognostic information in patients with heart failure with preserved ejection fraction (HFpEF). On the other hand, diastolic wall strain (DWS) has been recently introduced as a simple and feasible echocardiographic index in assessing left ventricular (LV) diastolic stiffness, and has been shown to be associated with poor outcome in patients with HFpEF. Hypothesis: We assessed the hypothesis that cardiac MIBG imaging and DWS might have a complementary prognostic value in HFpEF patients admitted for acute decompensated heart failure (ADHF). Methods: We studied 70 consecutive patients admitted for ADHF and discharged with survival whose LV ejection fraction measured by echocardiography was ≧40% (age: 77±12 years, male: 49%, NYHA class at discharge: 2.2±0.8). Cardiac MIBG imaging and echocardiography were performed just before discharge. The cardiac MIBG heart-to-mediastinum ratio (H/M) and washout rate were calculated from the chest anterior view images obtained at 20 and 200min after isotope injection. DWS was determined in the LV M-mode echocardiogram using a validated formula. The endpoints were unplanned hospitalization for worsening heart failure (WHF) and pump failure death (PFD). Results: During a follow-up period of 2.0±0.8 years, 20 patients had WHF and 7 patients had PFD. At multivariate Cox analysis, out of the variables including clinical, hemodynamic, biochemical, MIBG and echocardiographic parameters, H/M on delayed image (late H/M) and DWS were significantly independently associated with WHF (p=0.0058) and PFD (p=0.0160), respectively. Kaplan-Meier analysis showed that the patients with late H/M <1.73 (mean value) and those with DWS <0.292 (mean value) had a significantly higher risk of WHF and PFD, respectively (Figure). Conclusions: Cardiac MIBG imaging and DWS had a complementary prognostic value in HFpEF patients admitted for ADHF.