Reduced myocardial carbon-11 hydroxyephedrine retention is associated withpoor prognosis in chronic heart failure

Abnormalities of the autonomic nervous system are known to be of prognostic significance in chronic heart failure (CHF). The prognostic value of posit ron emission tomography (PET) imaging of cardiac autonomic innervation in C HF has not been explored previously. We retrospectively studied the surviva l data of 46 NYHA class II-III CHF patients (mean LVEF 35%+/-8%) who had un dergone carbon-11 hydroxyephe drine (C-11-HED) studies at the Turku PET Cen tre between August 1992 and March 1996. The origin of CHF was dilated cardi omyopathy in 13 of the 46 patients and coronary artery disease with at leas t one prior myocardial infarction in the remaining 33. Data on causes of de ath and heart transplantation were collected, and the statistically signifi cant predictors of prognosis were analysed using Cox's proportional hazards regression. During the mean follow-up period of 55 +/- 19 months, 11 death s occurred and two patients underwent heart transplantation successfully. E leven end-points were classified as cardiac (nine sudden cardiac deaths and two deaths due to progressive heart failure) and two as noncardiac. When d ivided into two groups based on the median of C-11-HED retention (mean 0.18 4 +/-0.061, median 0.183), eight end-points (death or cardiac transplantati on) were reached in the group with C-11-HED retention below the median and three in the group with C-11-HED retention above the median (P<0.02). In pr oportional hazards regression analysis, only peak oxygen uptake (peak VO2), left ventricular end-diastolic volume and HED retention were found to be s tatistically significant. It is concluded that C-11-HED PET provides indepe ndent prognostic information in patients with CHF.