Cardiac metaiodobenzylguanidine activity can predict the long-term efficacy of angiotensin-converting enzyme inhibitors and/or beta-adrenoceptor blockers in patients with heart failure

被引:47
作者
Nakata, T [1 ]
Wakabayashi, T [1 ]
Kyuma, M [1 ]
Takahashi, T [1 ]
Tsuchihashi, K [1 ]
Shimamoto, K [1 ]
机构
[1] Sapporo Med Univ, Sch Med, Dept Internal Med Cardiol 2, Chuo Ku, Sapporo, Hokkaido 0600061, Japan
关键词
heart failure; drug treatment; prognosis; autonomic nervous system; radionuclide imaging;
D O I
10.1007/s00259-004-1624-8
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose: Although the benefits of treatment with angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are well known, no method has as yet been established to predict the efficacy of drug therapy. This study tested whether cardiac I-123-metaiodobenzylguanidine (MIBG) activity is of prognostic value and can predict the improvement in heart failure patients resulting from treatment with ACE inhibitors and/or beta-blockers. Methods: Following quantification of the heart-to-mediastinum ratio (HMR) of MIBG activity, 88 patients with heart failure who were treated with ACE inhibitors and/or beta-blockers (treated group) and 79 patients with heart failure who were treated conventionally without the aforementioned agents, and who served as controls, were followed up for 43 months with a primary endpoint of cardiac death. Results: The treated group had a significantly lower prevalence of cardiac death and a significantly lower mortality at 5 years compared with the control group (15% vs 37% and 21% vs 42%, p<0.05, respectively). Multivariate analysis revealed that significant predictors were HMR, age, nitrate use and ventricular tachycardia for the treated group, and HMR, nitrate use and NYHA class for the control group. The drug treatment significantly reduced mortality from 36% to 12% when HMR was 1.53 or more and from 53% to 37% when HMR was less than 1.53. The reduction in risk of mortality within 5 years in patients without a severe MIBG defect (67%) was twice that in patients with such a defect (32%) (p<0.05). Conclusion: The reduction in mortality risk achieved by using ACE inhibitors and/or beta-blockers is associated with the severity of impairment of cardiac MIBG uptake. Cardiac MIBG activity can consequently be of long-term prognostic value in predicting the effectiveness of such treatment in patients with heart failure.
引用
收藏
页码:186 / 194
页数:9
相关论文
共 26 条
[1]   I-123 MIBG imaging and heart rate variability analysis to predict the need for an implantable cardioverter defibrillator [J].
Arora, R ;
Ferrick, KJ ;
Nakata, T ;
Kaplan, RC ;
Rozengarten, M ;
Latif, F ;
Ng, K ;
Marcano, V ;
Heller, S ;
Fisher, JD ;
Travin, MI .
JOURNAL OF NUCLEAR CARDIOLOGY, 2003, 10 (02) :121-131
[2]   Autonomic nervous system and sudden cardiac death [J].
Barron, HV ;
Lesh, MD .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1996, 27 (05) :1053-1060
[3]   Cardiac metaiodobenzylguanidine uptake in patients with moderate chronic heart failure: Relationship with peak oxygen uptake and prognosis [J].
Cohen-Solal, A ;
Esanu, Y ;
Logeart, D ;
Pessione, F ;
Dubois, C ;
Dreyfus, G ;
Gourgon, R ;
Merlet, P .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1999, 33 (03) :759-766
[4]   EFFECT OF VASODILATOR THERAPY ON MORTALITY IN CHRONIC CONGESTIVE-HEART-FAILURE - RESULTS OF A VETERANS-ADMINISTRATION COOPERATIVE STUDY [J].
COHN, JN ;
ARCHIBALD, DG ;
ZIESCHE, S ;
FRANCIOSA, JA ;
HARSTON, WE ;
TRISTANI, FE ;
DUNKMAN, WB ;
JACOBS, W ;
FRANCIS, GS ;
FLOHR, KH ;
GOLDMAN, S ;
COBB, FR ;
SHAH, PM ;
SAUNDERS, R ;
FLETCHER, RD ;
LOEB, HS ;
HUGHES, VC ;
BAKER, B .
NEW ENGLAND JOURNAL OF MEDICINE, 1986, 314 (24) :1547-1552
[5]   A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure [J].
Cohn, JN ;
Tognoni, G .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (23) :1667-1675
[6]   Cardiac sympathetic nerve function in congestive heart failure [J].
Eisenhofer, G ;
Friberg, P ;
Rundqvist, B ;
Quyyumi, AA ;
Lambert, G ;
Kaye, DM ;
Kopin, IJ ;
Goldstein, DS ;
Esler, MD .
CIRCULATION, 1996, 93 (09) :1667-1676
[7]   ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: Executive summary - A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the evaluation and management of heart failure) [J].
Hunt, SA ;
Baker, DW ;
Chin, MH ;
Cinquegrani, MP ;
Feldman, AM ;
Francis, GS ;
Ganiats, TG ;
Goldstein, S ;
Gregoratos, G ;
Jessup, ML ;
Noble, RJ ;
Packer, M ;
Silver, MA ;
Stevenson, LW ;
Gibbons, RJ ;
Antman, EM ;
Alpert, JS ;
Faxon, DP ;
Fuster, V ;
Gregoratos, G ;
Jacobs, AK ;
Hiratzka, LF ;
Russell, RO ;
Smith, SC .
CIRCULATION, 2001, 104 (24) :2996-3007
[8]   RESULTS OF SYMPATHETIC DENERVATION IN THE CANINE HEART - SUPERSENSITIVITY THAT MAY BE ARRHYTHMOGENIC [J].
INOUE, H ;
ZIPES, DP .
CIRCULATION, 1987, 75 (04) :877-887
[9]   ADVERSE CONSEQUENCES OF HIGH SYMPATHETIC NERVOUS ACTIVITY IN THE FAILING HUMAN HEART [J].
KAYE, DM ;
LEFKOVITS, J ;
JENNINGS, GL ;
BERGIN, P ;
BROUGHTON, A ;
ESLER, MD .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1995, 26 (05) :1257-1263
[10]   REGIONAL CARDIAC ADRENERGIC-FUNCTION USING I-123 METAIODOBENZYLGUANIDINE TOMOGRAPHIC IMAGING AFTER ACUTE MYOCARDIAL-INFARCTION [J].
MCGHIE, AI ;
CORBETT, JR ;
AKERS, MS ;
KULKARNI, P ;
SILLS, MN ;
KREMERS, M ;
BUJA, LM ;
DURANTREVILLE, M ;
PARKEY, RW ;
WILLERSON, JT .
AMERICAN JOURNAL OF CARDIOLOGY, 1991, 67 (04) :236-242