Abstract
The severity and prognosis of chronic hemodialysis patients with congestive heart failure (CHF) were determined by MIBG myocardial scintigraphy and echocardiography. The subjects were 32 patients (17 males, 15 females, mean age 58±16yr) who had undergone hemodialysis treatment for an average of 17yr. MIBG myocardial scintigraphy was obtained from SPECT and anterior planar images at 15min and 4hr after MIBG injection. Myocardial MIBG uptake was quantified by the heart-to-mediastinum uptake ratio on delayed planar images (H/M) and the mean myocardial MIBG washout rate at 4hr was calculated by using the Bull's eye map (MC). The mean lung MIBG washout rate at 4hr was also obtained from planar images (LC). The left ventricular end diastolic dimension (LVDd), percent fractional shortening (%FS), wall thickness (average thickness of the ventricular septum and the posterior wall) and the ratio of peak velocity of early rapid filling to peak velocity of inflow due to the atrial contraction (E/A) were measured by echocardiography. The patients were divided according to the severity of CHF: NYHA classification grade I or II (mild CHF group, n=24) vs grade III or IV (severe CHF group, n=8). The severe CHF group showed decreased H/M, LC and dilatation of LVDd (p<0.05). Twenty-two patients were clinically followed up for one and a half years. Seven had acute worsening of CHF and required admission to a hospital. The other 15 patients did not require admission. H/M and LC were decreased (p<0.05), and E/A was increased (p<0.05) in the former group. Eighteen of the 24 patients with mild CHF were followed up and classified according to the clinical course whether or not they had acute worsening of CHF. In the acute worsening group (n=4), H/M and LC were decreased, and E/A was increased compared with the non-acute worsening group (n=14) (p<0.05). Thus, H/M and LC indicate the severity and the prognosis of chronic hemodialysis patients with CHF. Dilatation of LVDd reflects the severity of CHF, but it cannot predict the clinical course, because LVDd is always reduced by the medication for CHF. Increased E/A was found in the acute worsening CHF group, but many factors influence the E/A value and increased E/A alone cannot be prognostic for the clinical course of CHF. In conclusion, MIBG scintigraphy was more useful, than echocardiography for determing the severity and prognosis of CHF in chronic hemodialysis patients.
