Many studies have shown that a one-time 123 I-metaiodobenzylguanidine ( 123 I-MIBG) scintigraphic study during a stable period is useful for determining the prognosis of patients with chronic heart failure (CHF). However, the findings from this imaging modality are well known to be improved by medical treatment for heart failure. Accordingly, this study was performed to determine whether serial 123 I-MIBG scintigraphic studies represent a reliable prognostic marker for patients with CHF. Methods: A total of 208 patients with CHF (left ventricular ejection fraction [LVEF] , 45%) and with no cardiac events for at least 5 mo were identified on the basis of a history of decompensated acute heart failure requiring hospitalization. The delayed percentage of denervation (% denervation), delayed heart-to-mediastinum count (H/M) ratio, and washout rate (WR) were determined from the patients' 123 I-MIBG images just before they left the hospital and after they had received 6 mo of treatment. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and LVEF were also determined by echocardiography at the same time points. Results: Of the 208 patients, 56 experienced fatal cardiac events during the study. The mean follow-up period was 4.45 6 1.82 y. The baseline H/M ratio and WR; follow-up % denervation, H/M ratio, and WR; D-% denervation, H/M ratio, and WR; baseline LVEF; follow-up LVEDV, LVESV, and LVEF; and D-LVEDV, D-LVESV, and D-LVEF were significantly worse in the cardiac death group. A Cox regression analysis showed that the D-WR was an independent predictor of cardiac death. Moreover, sudden death occurred in 13 of the 56 patients with cardiac death. A Cox regression analysis also showed that the D-WR was an incremental predictor of sudden death. The cardiac death-free rate and sudden death-free rate were significantly higher in patients with D-WR less than 25% and D-WR less than 22% than in patients with D-WR greater than or equal to 25% and D-WR greater than or equal to 22%. Conclusion: D-WR obtained from serial 123 I-MIBG scintigraphic studies can be useful for predicting cardiac death and sudden death in stabilized patients with CHF.

Spironolactone improves cardiac sympathetic nerve activity and LV remodeling in patients with DCM.

No abstract

Virtual Histology IVUS is a useful means of predicting the risk of distal embolization after primary stent deployment in patients with STEMI.

Background: Connective tissue growth factor (CTGF) has been recently reported as a mediator of myocardial fibrosis; however, the significance of plasma CTGF concentration has not been evaluated in patients with heart failure. The aim of this study was to investigate the clinical utility of plasma CTGF concentration for the diagnosis of heart failure. Methods and results: We evaluated fifty-two patients with chronic heart failure. The plasma concentration of CTGF and other markers of fibrosis were assessed and compared with clinical and echocardiographic data. Plasma CTGF was significantly elevated in symptomatic patients in proportion to their NYHA classes and was significantly correlated with plasma brain natriuretic peptide (BNP) concentration (r = 0.395, P b 0.01). Plasma CTGF was also correlated with plasma transforming growth factor beta (TGF-β) (r = 0.512, P b 0.01), matrix metalloproteinase (MMP)-2 (r = 0.391, P b 0.05) and tissue inhibitor of MMP (TIMP)-2 (r = 0.354, P b 0.05) concentrations. Interestingly, plasma CTGF was correlated with E/E' value evaluated by tissue Doppler echocardiography (r = 0.593, P = 0.012), but not with systolic function and left ventricular mass. Conclusion: Our study suggests that plasma CTGF concentration is a novel diagnostic marker for cardiac dysfunction and may provide additional specific information about myocardial fibrosis in chronic heart failure patients.