Cardiac Sympathetic Denervation and Ongoing Myocardial Damage for Prognosis in Early Stages of Heart Failure

Abstract Background Iodine-123-metaiodobenzylguanidine ( 123 I-MIBG) can assess cardiac sympathetic nervous function. Heart-type fatty acid binding protein (H-FABP) has been used as a marker of ongoing myocardial damage. The prognostic value of combination 123 I-MIBG imaging and H-FABP in heart failure is unknown. Methods and Results We prospectively enrolled consecutive 104 patients with heart failure in whom we quantified 123 I-MIBG scintigraphy, simultaneously measured serum H-FABP and plasma brain natriuretic peptide (BNP) levels, and analyzed clinical outcomes. The multivariate Cox regression analysis revealed that augmented H-FABP level and decreased heart to mediastinum ratio of 123 I-MIBG at 240 minutes (delayed H/M ratio), but not BNP, were the independent predictors for cardiac events. The cutoff values for H-FABP and delayed H/M ratio were determined from the receiver operating characteristic curves as 5.2 ng/mL for H-FABP and 1.73 for delayed H/M ratio. The cardiac event rate was markedly higher in patients with both H-FABP and delayed H/M ratio of 123 I-MIBG was abnormal. Conversely, no cardiac events occurred in patients with both H-FABP level and delayed H/M ratio were normal. Conclusion H-FABP adds independent prognostic information to delayed H/M ratio of 123 I-MIBG imaging, and the combination of these approaches may improve the accuracy of prognostic determination in heart failure.