Cohen-Solal A, Esanu Y, Logeart D, Pessione F, Dubois C, Dreyfus G, Gourgon R, Merlet P
Hôpitaux Beaujon, Clichy, France.
J Am Coll Cardiol. 1999 Mar;33(3):759-66. doi: 10.1016/s0735-1097(98)00608-1.
This prospective study was undertaken to correlate early and late metaiodobenzylguanidine (MIBG) cardiac uptake with cardiac hemodynamics and exercise capacity in patients with heart failure and to compare their prognostic values with that of peak oxygen uptake (VO2).
The cardiac fixation of MIBG reflects presynaptic uptake and is reduced in heart failure. Whether it is related to exercise capacity and has better prognostic value than peak VO2 is unknown.
Ninety-three patients with heart failure (ejection fraction <45%) were studied with planar MIBG imaging, cardiopulmonary exercise tests and hemodynamics (n = 44). Early (20 min) and late (4 h) MIBG acquisition, as well as their ratio (washout, WO) were determined. Prognostic value was assessed by survival curves (Kaplan-Meier method) and uni- and multivariate Cox analyses.
Late cardiac MIBG uptake was reduced (131+/-20%, normal values 192+/-42%) and correlated with ejection fraction (r = 0.49), cardiac index (r = 0.40) and pulmonary wedge pressure (r = -0.35). There was a significant correlation between peak VO2 and MIBG uptake (r = 0.41, p < 0.0001). With a mean follow-up of 10+/-8 months, both late MIBG uptake (p = 0.04) and peak VO2 (p < 0.0001) were predictive of death or heart transplantation, but only peak VO2 emerged by multivariate analysis. Neither early MIBG uptake nor WO yielded significant insights beyond those provided by late MIBG uptake.
Metaiodobenzylguanidine uptake has prognostic value in patients with wide ranges of heart failure, but peak VO2 remains the most powerful prognostic index.
本前瞻性研究旨在探讨心力衰竭患者早期和晚期间碘苄胍（MIBG）心脏摄取与心脏血流动力学及运动能力之间的相关性，并将其预后价值与峰值摄氧量（VO2）进行比较。
MIBG的心脏摄取反映突触前摄取，在心力衰竭时降低。其是否与运动能力相关以及是否比峰值VO2具有更好的预后价值尚不清楚。
对93例心力衰竭患者（射血分数<45%）进行了平面MIBG成像、心肺运动试验和血流动力学研究（n = 44）。测定早期（20分钟）和晚期（4小时）MIBG摄取及其比值（洗脱率，WO）。通过生存曲线（Kaplan-Meier法）以及单因素和多因素Cox分析评估预后价值。
晚期心脏MIBG摄取降低（131±20%，正常值192±42%），与射血分数（r = 0.49）、心脏指数（r = 0.40）和肺楔压（r = -0.35）相关。峰值VO2与MIBG摄取之间存在显著相关性（r = 0.41，p < 0.0001）。平均随访10±8个月，晚期MIBG摄取（p = 0.04）和峰值VO2（p < 0.0001）均为死亡或心脏移植的预测指标，但多因素分析仅显示峰值VO2有意义。早期MIBG摄取和WO均未提供超出晚期MIBG摄取的显著见解。
间碘苄胍摄取在广泛心力衰竭患者中具有预后价值，但峰值VO2仍然是最有力的预后指标。
