Patients with chronic heart failure (CHF) at risk of sudden cardiac death (SCD) are
often treated with implantable cardiac defibrillators (ICDs). However, current criteria
for device use that is based largely on left ventricular ejection fraction (LVEF)
lead to many patients receiving ICDs that never deliver therapy. It is of clinical
significance to identify patients who do not require ICDs. Although cardiac I-123
meta-iodobenzylguanidine (MIBG) imaging provides prognostic information about CHF,
whether it can identify patients with CHF who do not require an ICD remains unclear.
We studied 81 patients with CHF and LVEF <35%, assessed by cardiac MIBG imaging at
enrollment. The heart-to-mediastinal ratio (H/M) in delayed images and washout rates
were divided into 6 grades from 0 to 5, according to the degree of deviation from
control values. The study patients were classified into 3 groups: low (1 to 4), intermediate
(5 to 7), and high (8 to 10), according to the MIBG scores defined as the sum of the
H/M and washout rate scores. Sixteen patients died of SCD during a follow-up period.
Patients with low MIBG score had a significantly lower risk of SCD than those with
intermediate and high scores (low [n = 19], 0%; intermediate [n = 37], 19%; high [n =
25], 36%; p = 0.001). The positive predictive value of low MIBG score for identifying
patients without SCD was 100%. In conclusion, the MIBG score can identify patients
with CHF and LVEF <35% who have low risk of developing SCD.
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Article Info
Publication History
Published online: March 14, 2015
Accepted:
February 26,
2015
Received in revised form:
February 26,
2015
Received:
November 27,
2014
Footnotes
See page 1553 for disclosure information.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
