Dilated cardiomyopathy relieved as a result of β-blocker therapy: A case report—key points in assessment of prognosis based on MIBG myocardial scintigraphy and BNP levels

  • Shinro Matsuo
  • Ichiro Nakae
  • Daisuke Masuda
  • Tetsuya Matsumoto
  • Minoru Horie
Case Report


A 48-year-old male patient was admitted to our hospital with dyspnea accompanied by orthopnea. Chest x-rays showed a cardiothoracic ratio of 68% and pulmonary congestion. He was diagnosed with dilated cardiomyopathy. β-Blocker (Carvedilol) therapy was initiated on Day 22 of the disease using a small initial dose. He was followed up based on BNP levels and MIBG scintigraphy. The H/M ratio and MIBG washout rate were 1.98 and 33.4%, respectively, on. Day 20 and 2.15 and 28.1%, respectively, on Day 72. The patient was discharged on Day 72 when congestive heart failure improved. Relatively high BNP levels were observed for 1 month after starting treatment with a β-blocker. Plasma BNP levels were still as high when his heart failure was improved. BNP is useful as a convenient indicator for the severity of cardiac diseases. MIBG scintigraphy may be used thereafter to evaluate the severity in greater detail and more precisely determine the prognosis.

Key words

MIBG BNP prognosis heart failure 


  1. 1.
    Cohn JN, Levine TB, Olivari MT, et al. Plasma norepineph-rine as a guide to prognosis in patients with heart failure.N Engl J Med 1984; 311: 819–823.PubMedGoogle Scholar
  2. 2.
    Merlet P, Valette H, Dubois RJ, Moyse D, Duboc D, Dove P, et al. Prognostic value of cardiac metaiodobenzylguanidine imaging in patients with heart failure.J Nucl Med 1992; 33 (4): 471–477.PubMedGoogle Scholar
  3. 3.
    Matsuo S, Nakamura Y, Matsumoto T, Nakae I, Takada M, Murata K, et al. Prognostic value of Iodine-123 metaiodobenzylguanidine imaging in patients with heart failure.Exp Clin Cardiol 2003; 8 (2): 95–98.PubMedGoogle Scholar
  4. 4.
    Logeart D, Thabut G, Jourdain P, Chavelas C, Beyne P, Beauvais F, et al. Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure.J Am Coll Cardiol 2004; 43 (4): 635–641.PubMedCrossRefGoogle Scholar
  5. 5.
    Matsuo S, Takahashi M, Nakamura Y, Kinoshita M. Evaluation of cardiac sympathetic innervation with iodine-123-metaiodobenzylguanidine imaging in patients with silent myocardial ischemia.J Nucl Med 1996; 37: 712–717.PubMedGoogle Scholar
  6. 6.
    Matsuo S, Nakamura Y, Takahashi M, Matsui T, Kusukawa J, Yoshida S, et al. Cardiac sympathetic dysfunction in athlete’s heart detected by123IMIBG scintigraphy.Jpn Circ 72001; 65 (5): 371–374.CrossRefGoogle Scholar
  7. 7.
    Hasegawa K, Fujiwara H, Doyama K, Miyamae M, Fujiwara T, Suga S, et al. Ventricular expression of brain natriuretic peptide in hypertrophic cardiomyopathy.Circulation 1993; 88 (2): 372–380.PubMedGoogle Scholar
  8. 8.
    Yasumoto K, Takata M, Ueno H, Tomita S, Tomoda F, Inoue H. Relation of plasma brain and atrial natriuretic Peptides to left ventricular geometric patterns in essential hypertension.Am J Hypertens 1999; 12 (9 Pt 1): 921–924.PubMedCrossRefGoogle Scholar
  9. 9.
    Silvet H, Young-Xu Y, Walleigh D, Ravid S. Brain natriuretic peptide is elevated in outpatients with atrial fibrillation.Am J Cardiol 2003; 92 (9): 1124–1127.PubMedCrossRefGoogle Scholar
  10. 10.
    Matsuo S, Nakamura Y, Kinoshita M, Hone M. Plasma B-type natriuretic peptide measurement in asymptomatic population.International Medical Journal 2003; 10 (2): 105–108.Google Scholar
  11. 11.
    Fung JW, Yu CM, Yip G, Chan S, Yandle TG, Richards AM, et al. Effect of beta blockade (Carvedilol or metoprolol) on activation of the renin-angiotensin-aldosterone system and natriuretic peptides in chronic heart failure.Am J Cardiol 2003; 92 (4): 406–410.PubMedCrossRefGoogle Scholar
  12. 12.
    Yamazaki J, Muto H, Kabano T, Yamashina S, Nanjo S, Inoue A. Evaluation of beta-blocker therapy in patients with dilated cardiomyopathy—Clinical meaning of iodine 123-metaiodobenzylguanidine myocardial single-photon emission computed tomography.Am Heart J 2001; 141 (4): 645–652.PubMedCrossRefGoogle Scholar
  13. 13.
    Nakata T, Wakabayashi T, Kyuma M, Takahashi T, Tsuchihashi K, Shimamoto K. Cardiac metaiodobenzylguanidine activity can predict the long-term efficacy of angiotensin-converting enzyme inhibitors and/or beta-adrenoceptor blockers in patients with heart failure.Eur J Nucl Med Mol Imaging 2005; 32 (2): 186–194.PubMedCrossRefGoogle Scholar
  14. 14.
    Matsuo S, Nakamura Y, Matsui T, Matsumoto T, Kinoshita M. Detection of denervated but viable myocardium in cardiac sarcoidosis with 1-123 MIBG and Tl-201 SPECT Imaging.Ann Nucl Med 2001; 15: 373–375.PubMedGoogle Scholar
  15. 15.
    Matsuo S, Nakamura Y, Matsumoto T, Takahashi M, Kinoshita M. Detection of coronary microvascular disease by means of cardiac scintigraphy.Can J Cardiol 2002; 18 (2): 183–186.PubMedGoogle Scholar
  16. 16.
    Matsuo S, Nakamura Y, Tsutamoto T, Kinoshita M. Impairments of myocardial sympathetic activity may reflect the progression of myocardial damage or dysfunction in hyper-trophic cardiomyopathy.J Nucl Cardiol 2002; 9 (4): 407–412.PubMedCrossRefGoogle Scholar
  17. 17.
    Matsuo S, Nakae I, Takada M, Murata K, Nakamura Y. Noninvasive identification of myocardial sympathetic and metabolic abnormalities in a patient with restrictive cardiomyopathy —in comparison with perfusion imaging—.Ann Nucl Med 2002; 16 (8), 569–572.PubMedGoogle Scholar
  18. 18.
    Imamura Y, Fukuyama T, Mochizuki T, Miyagawa M, Watanabe K; Ehime MIBG Heart Failure Study Investigators. Prognostic value of iodine-123-metaiodobenzyl-guanidine imaging and cardiac natriuretic peptide levels in patients with left ventricular dysfunction resulting from cardiomyopathy.Jpn Circ J 2001; 65 (3): 155–160.PubMedCrossRefGoogle Scholar
  19. 19.
    Matsuo S, Matsumoto T, Nakae I, Koh T, Masuda D, Takada M, et al. Prognostic value of ECG-gated thallium-201 single-photon emission tomography in patients with coronary artery disease.Ann Nucl Med 2004; 18 (7): 617–622.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Shinro Matsuo
    • 1
  • Ichiro Nakae
    • 1
  • Daisuke Masuda
    • 1
  • Tetsuya Matsumoto
    • 1
  • Minoru Horie
    • 1
  1. 1.Department of Cardiovascular and Respiratory MedicineShiga University of Medical ScienceSeta, Otsu, ShigaJapan

Personalised recommendations