Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
Am J Cardiol. 2011 Apr 15;107(8):1185-90. doi: 10.1016/j.amjcard.2010.12.019. Epub 2011 Feb 23.
The Seattle Heart Failure Model (SHFM) is a validated prediction model that estimates the mortality in patients with chronic heart failure (CHF) using commonly obtained information, including clinical data, laboratory test results, medication use, and device implantation. In addition, cardiac iodine-123 meta-iodobenzylguanidine (MIBG) imaging provides prognostic information for patients with CHF. However, the long-term predictive value of combining the SHFM and cardiac MIBG imaging in patients with CHF has not been elucidated. To prospectively investigate whether cardiac iodine-123 MIBG imaging provides additional prognostic value to the SHFM in patients with CHF, we studied 106 outpatients with CHF who had radionuclide left ventricular ejection fraction < 40% (30 ± 8%). The SHFM score was obtained at enrollment, and the cardiac MIBG washout rate (WR) was calculated from anterior chest images obtained at 20 and 200 minutes after isotope injection. During a mean follow-up of 6.8 ± 3.5 years (range 0 to 13), 32 of 106 patients died from cardiac causes. A multivariate Cox analysis revealed that the WR (p = 0.0002) and SHFM score (p = 0.0091) were independent predictors of cardiac death. Kaplan-Meier analysis showed that patients with an abnormal WR (> 27%) had a significantly greater risk of cardiac death than did those with a normal WR for both those with a SHFM score of ≥ 1 (relative risk 3.3, 95% confidence interval 1.2 to 9.7, p = 0.01) and a SHFM score of ≤ 0 (relative risk 3.4, 95% confidence interval 1.2 to 9.6, p = 0.004). In conclusion, the cardiac MIBG WR provided additional prognostic information to the SHFM score for patients with CHF.
西雅图心力衰竭模型（SHFM）是一种经过验证的预测模型，可使用临床数据、实验室检查结果、药物使用和器械植入等常用信息来估计慢性心力衰竭（CHF）患者的死亡率。此外，心脏碘-123 间碘苄胍（MIBG）显像可为 CHF 患者提供预后信息。然而，尚未阐明将 SHFM 与心脏 MIBG 成像相结合在 CHF 患者中的长期预测价值。为前瞻性研究心脏碘-123 MIBG 显像在 CHF 患者中的 SHFM 是否提供了额外的预后价值，我们研究了 106 名患有放射性核素左心室射血分数<40%（30±8%）的门诊 CHF 患者。在入组时获得 SHFM 评分，并从注射同位素后 20 分钟和 200 分钟获得前胸部图像计算心脏 MIBG 洗脱率（WR）。在平均 6.8±3.5 年（0 至 13 年）的随访期间，106 名患者中有 32 名死于心脏原因。多变量 Cox 分析显示 WR（p=0.0002）和 SHFM 评分（p=0.0091）是心脏死亡的独立预测因素。Kaplan-Meier 分析显示，WR 异常（>27%）的患者发生心脏死亡的风险明显高于 WR 正常的患者，无论 SHFM 评分≥1（相对危险度 3.3，95%置信区间 1.2 至 9.7，p=0.01）还是 SHFM 评分≤0（相对危险度 3.4，95%置信区间 1.2 至 9.6，p=0.004）。总之，心脏 MIBG WR 为 CHF 患者的 SHFM 评分提供了额外的预后信息。
