Prognostic Value of I-123 Metaiodobenzylguanidine Imaging in Vasospastic Angina Without Significant Coronary Stenosis
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概要
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Background Myocardial imaging is widely used to detect coronary artery disease and to assess its prognosis. In vasospastic angina (VA), cardiac imaging can provide information on disease activity, which is related to cardiac events. The aim of this study was to clarify whether exercise thallium-201 imaging (Tl-SPECT) and ^<123>I-metaiodobenzylguanidine imaging (MIBG) have prognostic value for patients with VA, but without significant coronary artery stenosis. Methods and Results One hundred and 5 patients who showed acetylcholine-induced coronary spasm, normal left ventricular function and no significant stenosis (<50%) underwent both symptom-limited Tl-SPECT and MIBG within 1 month. All patients were prescribed calcium antagonist during the follow-up period (mean 4.7 years). Exercise-induced ischemia was detected by Tl-SPECT in 53 patients and multivessel coronary spasm by coronary angiography in 33 patients. During the follow-up period, 1 patient died suddenly and another died of acute myocardial infarction (MI). Two patients developed nonfatal acute MI and 7 patients underwent emergency coronary angiography because of unstable angina. According to the baseline characteristics, VA with cardiac events showed a significantly higher heart-to-mediastinum ratio (H/M ratio) and a significantly lower MIBG washout rate than those without cardiac events (p<0.03 arid p<0.02, respectively). Among 8 clinical variables, including coronary risk factors, exercise parameters and exercise-induced ischemia on Tl-SPECT and the MIBG delayed H/M ratio and washout rate, univariate Cox proportional hazard regression analysis showed that the high H/M ratio and reduced washout rate of MIBG were significant predictors of future cardiac events (relative risk (RR)=4, confidence interval (CI)=1.21-13.29, p<0.02 for H/M ratio and RR 0.92, CI 0.85-0.99, p<0.02 for washout rate). However, exercise-induced ischemia did not show any statistical significance. By multivariate Cox proportional hazard regression analysis, a reduced MIBG washout rate was the only significant predictor of future cardiac events (odds ratio=0.90, CI =0.82-1,00, p<0.04). Conclusion MIBG imaging can identify high-risk patients, even among those with VA who were previously regarded as low risk. This result strongly supports the idea that cardiac sympathetic dysfunction contributes to coronary artery spasm leading to cardiac events.
- 2005-01-20
著者
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YOSHIDA Hiroshi
Department of Clinical Laboratory Medicine, Fukushima Medical College
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Sakata Kazuyuki
Division of Cardiology, Shizuoka Cancer Center Hospital
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Iida Kei
Division of Cardiology, Shizuoka Cancer Center Hospital
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DOI Osamu
Department of Animal Science and Technology, Faculty of Agriculture, Gifu University
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Kudo Masahiro
Division of Cardiology, Shizuoka Cancer Center Hospital
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Sakata Kazuyuki
Division Of Cardiology Shizuoka Cancer Center Hospital
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Iida Kei
Division Of Cardiology Shizuoka Cancer Center Hospital
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Iida Kei
Division Of Biological Science Graduate School Of Science Nagoya University
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Yoshida Hiroshi
Department Of Biophysics Graduate School Of Science Kyoto University
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Yoshida Hiroshi
Department Of Cardiology Shizuoka General Hospital
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Kudo Masahiro
Division Of Cardiology Shizuoka Cancer Center Hospital
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Yoshida Hiroshi
Departmen Of Radiology School Of Medicine Asahikawa Medical University
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