Heart failurePrognostic Value of Iodine-123-Metaiodobenzylguanidine Myocardial Uptake and Heart Rate Variability in Chronic Congestive Heart Failure Secondary to Ischemic or Idiopathic Dilated Cardiomyopathy
Section snippets
Patient population
The study population consisted of 52 consecutive patients with stable, chronic CHF, with left ventricular ejection fractions <40% by radionuclide ventriculography. Patients with atrial fibrillation or paced rhythms were excluded. The follow-up period was 2 years. With an expected mortality of 30% at 2 years, it was estimated that an adequate number of events would be available at the completion of the follow-up to allow prognostic assessments, at least univariately. At enrollment into the
Results
During a follow-up of 2 years, 14 patients (27%) died, 4 suddenly. The baseline characteristics, MIBG uptake, and HRV parameters measured in the overall patient population are listed in Table 1. The mean values of these same parameters in survivors versus nonsurvivors are compared in Table 2. There was a significant difference in the left ventricular ejection fraction and I-123-MIBG uptake at 1 hour between the 2 groups and a trend toward a significant difference at the 4-hour uptake. Of the
Discussion
I-123-MIBG uptake and HRV have been validated to assess the effects of the autonomic nervous system on cardiac function. MIBG is a noradrenaline analog taken up by cardiac sympathetic nerve endings, reflecting local sympathetic activity. A strong correlation between MIBG myocardial uptake and noradrenaline content in endomyocardial biopsy samples has been reported.9 In ischemic and dilated cardiomyopathy, regions of myocardial necrosis and fibrosis have reduced sympathetic innervation, which is
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