Abstract
The aim of this study was to explore if estimates of renal function could explain variability of 123I-metaiodobenzylguanidine (123I-MIBG) assessed myocardial sympathetic activity. Furthermore estimates of renal function were compared to 123I-MIBG as predictors of cardiac death in chronic heart failure (CHF). Semi-quantitative parameters of 123I-MIBG myocardial uptake and washout were calculated using early heart/mediastinum ratio (H/M), late H/M and washout. Renal function was calculated as estimated Creatinine Clearance (e-CC) and as estimated Glomerular Filtration Rate (e-GFR). Thirty-nine patients with CHF (24 males; age: 64.4 ± 10.5 years; NYHA II/III/IV: 17/20/2; LVEF: 24.0 ± 11.5%) were studied. Variability in any of the semi-quantitative 123I-MIBG myocardial parameters could not be explained by e-CC or e-GFR. During follow-up (60 ± 37 months) there were 6 cardiac deaths. Cox proportional hazard regression analysis showed that late H/M was the only independent predictor for cardiac death (Chi-square 3.2, regression coefficient: −4.095; standard error: 2.063; hazard ratio: 0.17 [95% CI: 0.000–0.950]). Addition of estimates of renal function did not significantly change the Chi-square of the model. Semi-quantitative 123I-MIBG myocardial parameters are independent of estimates of renal function. In addition, cardiac sympathetic innervation assessed by 123I-MIBG scintigraphy seems to be superior to renal function in the prediction of cardiac death in CHF patients.
Highlights
The myocardial sympathetic nervous system is activated in patients with chronic heart failure (CHF) and has been shown to be associated with increased mortality
Renal function was calculated as estimated Creatinine Clearance (e-CC) and as estimated Glomerular Filtration Rate (e-glomerular filtration rate (GFR))
Semi-quantitative 123I-MIBG myocardial parameters are independent of estimates of renal function
Summary
The myocardial sympathetic nervous system is activated in patients with chronic heart failure (CHF) and has been shown to be associated with increased mortality. Cardiac sympathetic innervation can be scintigraphically visuali-zed by 123I-metaiodobenzylguanidine (123I-MIBG), a radiolabelled analog of noradrenalin and has been shown to be a powerful prognostic marker in patients with CHF [1, 2]. In addition to 123I-MIBG there are many other prognostic markers in patients with CHF. In patients with chronic renal failure myocardial washout of 123I-MIBG, as a measure of increased myocardial sympathetic activity, has been shown to be increased [6]. Major clinical trials aimed to assess the prognostic value of 123I-MIBG have often excluded patients with substantial renal failure, further limiting the amount of prognostic information comparing these two variables [2]
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