Prognostic Significance Of Cardiac I-123-Metaiodobenzylguanidine Imaging In Patients With Reduced, Mid-Range, And Preserved Left Ventricular Ejection Fraction Admitted For Acute Decompensated Heart Failure: A Prospective Study In Osaka Prefectural Acute Heart Failure Registry (Opar)

Aims Cardiac I-123-metaiodobenzylguanidine (I-123-MIBG) imaging provides prognostic information in patients with chronic heart failure (HF). However, there is little information available on the prognostic role of cardiac I-123-MIBG imaging in patients admitted for acute decompensated heart failure (ADHF), especially relating to reduced ejection fraction [HFrEF; left ventricular ejection fraction (LVEF) < 40%], mid-range ejection fraction (HFmrEF; 40% <= LVEF < 50%) and preserved ejection fraction (HFpEF; LVEF >= 50%).Methods and results We studied 349 patients admitted for ADHF and discharged with survival. Cardiac I-123-MIBG imaging, echocardiography, and venous blood sampling were performed just before discharge. The cardiac I-123-MIBG heart-to-mediastinum ratio (late H/M) was measured on the chest anterior view images obtained at 200 min after the isotope injection. The endpoint was cardiac events defined as unplanned HF hospitalization and cardiac death. During a follow-up period of 2.1 +/- 1.4 years, 128 patients had cardiac events (45/127 in HFrEF, 28/78 in HFmrEF, and 55/144 in HFpEF). On multivariable Cox analysis, late H/M was significantly associated with cardiac events in overall cohort (P = 0.0038), and in subgroup analysis of each LVEF subgroup (P = 0.0235 in HFrEF, P = 0.0119 in HFmEF and P = 0.0311 in HFpEF). Kaplan-Meier analysis showed that patients with low late H/M (defined by median) had significantly greater risk of cardiac events in overall cohort (49% vs. 25% P < 0.0001) and in each LVEF subgroup (HFrEF: 48% vs. 23% P = 0.0061, HFmrEF: 51% vs. 21% P = 0.0068 and HFpEF: 50% vs. 26% P = 0.0026).Conclusion Cardiac sympathetic nerve dysfunction was associated with poor outcome in ADHF patients irrespective of HFrEF, HFmrEF, or HFpEF.