Prognostic Value of Cardiac Iodine-123 Metaiodobenzylguanidine Imaging in Patients With Reduced and Preserved Left Ventricular Ejection Fraction Admitted for Acute Decompensated Heart Failure

Background: Cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging has been shown to provide prognostic information in patients with heart failure. However, little is known about the difference in prognostic value of sympathetic nerve activity between the patients with heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF) admitted for acute decompensated heart failure (ADHF). Methods: We studied 153 consecutive patients admitted for ADHF and discharged with survival (age: 74±13 yrs, male: 56%, NYHA class at discharge: 2.0±0.8, left ventricular ejection fraction [LVEF]: 46±15%). Cardiac MIBG imaging, echocardiography and venous blood sampling were performed just before discharge. The cardiac MIBG heart-to-mediastinum ratio (HMR) and washout rate (WR) were calculated from the chest anterior view images obtained at 20 and 200min after isotope injection. The endpoint was unplanned hospitalization for worsening heart failure (WHF). Results: There were 77 patients with HFrEF (LVEF Conclusions: Cardiac sympathetic nerve overactivity was associated with poor outcome both in HFrEF and HFpEF patients, although cardiac sympathetic nerve activity was higher in HFrEF patients than in HFpEF patients.