O11-5 - Cardiac Sympathetic Nerve Activity and Left Ventricular Dyssynchrony Can Predict Long-Term Prognosis in Heart Failure Patients with Systolic Dysfunction

Abstract

Backgrounds: Left ventricular (LV) dyssynchrony is said to be involved in prognosis of heart failure (HF) patient with reduced LV ejection fraction(rLVEF). But it is not demonstrated the relationship between the prognosis of HF and LV dyssynchrony quantifiable by cardiac scintigraphy.This study aimed to investigate whether autonomic innervation quantified by metaiodobenzylguanidine(MIBG) and LV dyssynchrony measured by Phase SD of rest 99mTc (Tetrofosmin) have an independent and additive prognostic value in HF patients. Methods: Consecutive 478 HF patients with rLVEF were followed up for 22.6 months after quantification of MIBG activity as a heart-to-mediastinum ratio(HMR) and washout-rate,and LV dyssynchrony as Phase SD of 99mTc were compared with cardiac event(CE) group and non-CE group. Results: During a follow-up,CE was documented only in 132 of HF patients.The CE patient group had a greater washout-rate(29.8% VS 27.1% P = .0059)and a lower earlyHMR(1.60 VS 1.75 P < .0001)and a lower lateHMR(1.42 VS 1.63 P < .0001)and higher Phase SD(39.1 VS 33.3 P < .0001)than non-CE group.HF patients with late HMR < 1.60 demonstrated a significant greater CE rate compared with those without(P < .0001).HF patients with Phase SD > 37 demonstrated a significant greater CE rate compared with those without(P < .0001).HF patients with both late HMR < 1.60 and Phase SD > 37 showed a significant greater CE rate compared with the other patients(P < .0001). Conclusions: LV dyssynchrony as Phase SD of 99mTc and impaired cardiac sympathetic innervation defined as a lateHMR independently predict cardiac mortality risk in HF patients with rLVEF.