P6215
Prognostic value of advanced lung cancer inflammation index in patients with chronic heart failure: a prospective comparative study with cardiac I-123 metaiodobenzylguanidine imaging

Extract

Background: Recently, nutritional status and systemic inflammation are reported as robust prognostic factor in chronic heart failure (CHF) patients. Advanced lung cancer inflammation index (ALI), which is calculated as body mass index × serum albumin / neutrophil to lymphocyte ratio (NLR), is an independent prognostic marker in several types of cancer. On the other hand, cardiac I-123 metaiodobenzylguanidine (MIBG) imaging, which is useful for the estimation of cardiac adrenergic nerve activity, provides prognostic information in CHF patients. However, there is no information available on the comparison of prognostic value of cardiac MIBG imaging and ALI in CHF patients.

Methods and results: We studied 104 CHF outpatients with LVEF <40% in our prospective cohort study. The cardiac MIBG heart-to-mediastinum ratio (H/M) washout rate (WR) were calculated from the chest anterior view images obtained at 20 and 200 min after isotope injection. Abnormal WR was defined as WR≥27%. We also measured laboratory data and echocardiography at entry. During a follow up period of 6.3±4.5 years, 51 patients had cardiac events, defined as readmission for worsening heart failure or cardiac death. At multivariate Cox analysis, ALI (p=0.03), WR (p=0.001), serum sodium level (p=0.02), uric acid level (p=0.004) and LVEF (p=0.002) were significantly associated with cardiac event independently of serum creatinine level. The receiver operator characteristic curve (ROC) analysis revealed that ALI of 49.29 was a fair discriminator for cardiac event (area under the curve 0.743 (95% CI 0.648–0.824)). Kaplan-Meier analysis revealed that patients with low ALI had a significantly greater risk of cardiac event (68% vs 21% p<0.0001, adjusted HR 4.22 [2.05–8.70]). Kaplan-Meier analysis revealed that patients with both low ALI and abnormal WR had a significantly greater risk of the mortality than those with either low ALI or abnormal WR (85% vs 38% p=0.0005, adjusted HR 2.92 [1.56–5.46]). Furthermore, patients with either low ALI or abnormal WR also had a significantly greater risk of the mortality than those with neither low ALI nor abnormal WR (38% vs 14% p=0.016, adjusted HR 3.62 [1.19–11.04]).