Predictors of outcome in patients with de novo diagnosis of heart failure with reduced ejection fraction: Role of combined myocardial and lung Iodine-123 Meta-Iodobenzylguanidine imaging

  • Angelo Silverio
  • Maria Vincenza Polito
  • Leonardo Pace
  • Federica D’Auria
  • Gennaro Vitulano
  • Massimo Scarano
  • Rodolfo Citro
  • Gennaro GalassoEmail author
  • Federico Piscione
Original Article



The predictors of outcome in patients with de novo diagnosis of heart failure (HF) with reduced ejection fraction (HFrEF) are poorly known.

Methods and Results

All consecutive HFrEF patients admitted between October 2012 and November 2017 with their first episode of HF were scheduled for an outpatient follow-up. After 3 months, patients with confirmed HFrEF underwent Iodine-123 Meta-Iodobenzylguanidine imaging. We defined three study endpoints: HF rehospitalization, cardiac death and all-cause death. Eighty-four patients were enrolled. During follow-up (39.9 ± 18.6 months) HF rehospitalization occurred in 33 cases, cardiac death in 18 and all-cause death in 24. At multivariate analysis, systolic pulmonary arterial pressure (sPAP; HR: 1.047; p = .027) and Late lung to heart ratio (L/H; HR: 1.341; p < .001) independently predict HF rehospitalization; left ventricular end-systolic volume (LVESV; HR: 1.016; p = .017), sPAP (HR: 1.064; p = .034) and Late L/H (HR: 1.323; p = .009) were predictors of cardiac death; LVESV (HR: 1.013; p = .018) and Late L/H (HR: 1.245; p = .012) were independent predictors of all-cause death. Kaplan–Meier analysis of the individual predictors confirmed their prognostic ability during follow-up; of note, the Late L/H cut-off of 1.1 improved the risk stratification capability of echocardiographic parameters.


Late L/H independently predicts HF rehospitalization, cardiac death and all-cause death in patients with de novo diagnosis of HFrEF and improves the prognostic stratification capability of conventional echocardiographic parameters.


Heart failure single-photon emission computed tomography echocardiography Iodine-123 Meta-Iodobenzylguanidine 



Heart failure


Heart failure with reduced ejection fraction


Heart to mediastinum ratio


Iodine-123 Meta-Iodobenzylguanidine


Lung to heart ratio


Lung to mediastinum ratio


Left ventricular ejection fraction


Left ventricular end-systolic volume


New York Heart Association


Systolic pulmonary artery pressure



No conflict of interest or any financial support to declare.

Supplementary material

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Supplementary material 1 (DOCX 71 kb)
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Supplementary material 2 (PPTX 2344 kb)


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Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • Angelo Silverio
    • 1
  • Maria Vincenza Polito
    • 1
  • Leonardo Pace
    • 2
  • Federica D’Auria
    • 1
  • Gennaro Vitulano
    • 1
  • Massimo Scarano
    • 3
  • Rodolfo Citro
    • 1
  • Gennaro Galasso
    • 1
    • 2
    Email author
  • Federico Piscione
    • 1
    • 2
  1. 1.U.O.C. Cardiologia, Dipartimento Cardio-Toraco-VascolareA.O.U. San Giovanni di Dio e Ruggi d’AragonaSalernoItaly
  2. 2.Dipartimento di Medicina, Chirurgia ed Odontoiatria “Scuola Medica Salernitana”Università degli Studi di SalernoFiscianoItaly
  3. 3.U.O.C. Medicina Nucleare, Dipartimento di Diagnostica per Immagini e RadioterapiaA.O.U. San Giovanni di Dio e Ruggi d’AragonaSalernoItaly

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