Myocardial beta-adrenoceptor Density Early After Infarction Predicts Long Term Incidence of Congestive Heart Failure

Aims Adverse left ventricular (LV) remodeling after myocardial infarction (MI) frequently leads to congestive heart failure (CHF). We have previously shown that myocardial β-adrenoceptor density (β-ARD) is reduced soon after acute MI and correlates with LV dilatation in the short term. The aim of the present study was to determine whether myocardial β-ARD measured early after MI was associated with progression to CHF in the long term.Methods and results We prospectively included 61 consecutive patients (mean age, 52±11 years, 10 female) in whom MI was the first manifestation of coronary artery disease. Two to 4 weeks after MI, patients underwent positron emission tomography with S-[11C]CGP 12177 to measure β-ARD and 15O labelled water to measure myocardial blood flow (MBF) and coronary flow reserve (CFR). Patients were followed-up for a median of 12.7 years (interquartile range, 6.5-13.7 years) and incidence of CHF was recorded. Eleven patients (18%) developed CHF during follow-up. They had lower β-ARD compared to those who did not (5.35 vs 6.49 pmol/g, P<0.001). In patients with myocardial β-ARD ≤5.57 pmol/g, 10-year CHF incidence rates were higher than in patients with β-ARD >5.57 pmol/g (57% vs. 9%, P<0.001). In a Cox regression model only whole heart β-ARD (HR 0.29; 95% CI, 0.15-0.58, P<0.001) and β-ARD in remote myocardium (HR 0.32; 95% CI, 0.16-0.61, P=0.001) were significantly associated with the incidence of CHF at follow-up. Conclusion Reduced myocardial β-ARD early after MI is associated with the incidence of CHF on long term follow-up.