Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
Ann Nucl Med. 2011 Jul;25(6):419-24. doi: 10.1007/s12149-011-0479-x. Epub 2011 Apr 2.
(123)I-metaiodobenzylguanidine (MIBG) scintigraphy is a useful tool for predicting the prognosis in patients with congestive heart failure; however, little is known regarding long-term prognostic evaluations. The aim of this study was to evaluate long-term prognosis in a roughly 10-year period, in dilated cardiomyopathy (DCM) by MIBG imaging, compared to other conventional functional parameters.
Eighty-six DCM patients (50 ± 14 years of age, 57 males) underwent MIBG imaging, at 15 min and 4 h after tracer injection, from which the delayed heart to mediastinum ratio (H/M) and washout rate (WR) were obtained. The left ventricular ejection fraction (EF) and end-diastolic diameter (LVDd) were also measured by echocardiogram. All patients were followed up for 8-14 years, and the death event was investigated.
Kaplan-Meier curves revealed a poor prognosis only in the group above the third quartile of WR (=50%) (10-year prognosis, 35%); however, there were no statistically significant differences in prognosis among the other 3 groups (10-year prognosis, 75-84%). A Cox hazard univariate analysis selected WR (p = 0.0004), H/M (p < 0.0001), EF (p = 0.0024), and LVDd (p = 0.0189) as significant prognostic indicators. Multivariate analysis revealed the H/M (p = 0.0023) and EF (p = 0.024) to be an independent prognostic predictor. The 10-year prognosis of patients with both WR < 50% and EF > 30%; WR < 50% and EF < 30%; and both WR > 50% and EF < 30% were 89, 71, and 33%, respectively. These three groups were well stratified, significantly (log-rank test: χ (2) = 30.0, p < 0.0001). However, even patients with WR ≥ 50% had few death events after 3 years following MIBG imaging.
The MIBG parameter, delayed H/M or WR combined with the EF is a useful tool for the prediction of a long-term prognosis in DCM, which is superior to MIBG parameters alone. However, patients with WR > 50% but no event in a 3-year follow-up period should undergo an additional MIBG imaging for prognostic prediction.
（123）碘代苄胍（MIBG）闪烁显像术是预测充血性心力衰竭患者预后的有用工具；然而，对于长期预后评估知之甚少。本研究旨在通过 MIBG 成像评估扩张型心肌病（DCM）患者在大约 10 年期间的长期预后，并与其他常规功能参数进行比较。
86 例 DCM 患者（50±14 岁，男性 57 例）接受 MIBG 显像，在示踪剂注射后 15 分钟和 4 小时获得延迟心脏与纵隔比值（H/M）和洗脱率（WR）。还通过超声心动图测量左心室射血分数（EF）和舒张末期直径（LVDd）。所有患者均随访 8-14 年，调查死亡事件。
Kaplan-Meier 曲线显示仅 WR 高于第三四分位数（=50%）的患者预后不良（10 年预后，35%）；然而，其他 3 组之间的预后无统计学差异（10 年预后，75-84%）。Cox 风险单因素分析选择 WR（p=0.0004）、H/M（p<0.0001）、EF（p=0.0024）和 LVDd（p=0.0189）作为显著预后指标。多因素分析显示 H/M（p=0.0023）和 EF（p=0.024）是独立的预后预测因子。WR<50%且 EF>30%；WR<50%且 EF<30%；WR>50%且 EF<30%的患者 10 年预后分别为 89%、71%和 33%。这三组分层良好，差异显著（对数秩检验：χ²（2）=30.0，p<0.0001）。然而，即使 WR≥50%的患者在 MIBG 成像后 3 年也很少发生死亡事件。
MIBG 参数，即延迟 H/M 或 WR 与 EF 结合，是预测 DCM 长期预后的有用工具，优于单独的 MIBG 参数。然而，WR>50%但在 3 年随访期间无事件的患者应进行额外的 MIBG 成像以进行预后预测。
