在因急性失代偿性心力衰竭住院的射血分数降低、中范围和保留的左心室射血分数患者中，心脏 I-123-间碘苄胍成像的预后意义：大阪府急性心力衰竭登记处（OPAR）的前瞻性研究。
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).
机构信息
Division of Cardiology, Osaka General Medical Center, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan.
Division of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
出版信息
Eur Heart J Cardiovasc Imaging. 2021 Jan 1;22(1):58-66. doi: 10.1093/ehjci/jeaa025.
AIMS
Cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging provides prognostic information in patients with chronic heart failure (HF). However, there is little information available on the prognostic role of cardiac 123I-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 123I-MIBG imaging, echocardiography, and venous blood sampling were performed just before discharge. The cardiac 123I-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.
目的
心脏 123I-间位碘代苄胍（123I-MIBG）成像可提供慢性心力衰竭（HF）患者的预后信息。然而，关于心脏 123I-MIBG 成像在因急性失代偿性心力衰竭（ADHF）入院的患者中的预后作用，特别是在射血分数降低（HFrEF；左心室射血分数 [LVEF] <40%）、中间范围射血分数（HFmrEF；40%≤LVEF<50%）和保留射血分数（HFpEF；LVEF≥50%）的患者中，相关信息较少。
方法和结果
我们研究了 349 名因 ADHF 入院并存活出院的患者。在出院前进行心脏 123I-MIBG 成像、超声心动图和静脉血采样。在注射同位素后 200 分钟时，在胸部前位图像上测量心脏 123I-MIBG 心/纵隔比（晚期 H/M）。终点是未计划的 HF 住院和心脏死亡定义的心脏事件。在 2.1±1.4 年的随访期间，128 名患者发生了心脏事件（HFrEF 中 45/127，HFmrEF 中 28/78，HFpEF 中 55/144）。多变量 Cox 分析显示，晚期 H/M 与整个队列的心脏事件显著相关（P=0.0038），并且在每个 LVEF 亚组的亚组分析中也是如此（HFrEF 中 P=0.0235，HFmrEF 中 P=0.0119，HFpEF 中 P=0.0311）。Kaplan-Meier 分析显示，整个队列中晚期 H/M 较低（定义为中位数）的患者发生心脏事件的风险显著增加（49%比 25%，P<0.0001），并且在每个 LVEF 亚组中也是如此（HFrEF：48%比 23%，P=0.0061，HFmrEF：51%比 21%，P=0.0068，HFpEF：50%比 26%，P=0.0026）。
结论
心脏交感神经功能障碍与 ADHF 患者的不良预后相关，无论是否存在 HFrEF、HFmrEF 或 HFpEF。
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