Myocardial Iodine-123 Meta-Iodobenzylguanidine Imaging and Cardiac Events in Heart Failure Results of the Prospective ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) Study

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:55

Article

Jacobson, Arnold F.²  Senior, Roxy³  Cerqueira, Manuel D.⁴  Wong, Nathan D.¹  Thomas, Gregory S.¹  Lopez, Victor A.¹  Agostini, Denis⁵  Weiland, Fred⁶  Chandna, Harish⁷  Narula, Jagat¹ 

[1] Univ Calif Irvine, Irvine, CA USA

[2] GE Healthcare, Princeton, NJ USA

[3] Northwick Pk Hosp & Clin Res Ctr, London, England

[4] Cleveland Clin Fdn, Cleveland, OH 44195 USA

[5] Ctr Hosp Univ Cote de Nacre, Caen, France

[6] Sutter Roseville Hosp, Roseville, CA USA

[7] Victoria Heart, Victoria, TX USA

关键词: sympathetic nervous system;    radionuclide imaging;    heart failure;    prognosis;    cardiomyopathy;    mIBG;   

DOI  :  10.1016/j.jacc.2010.01.014

来源: Elsevier

【 摘 要 】

Objectives The ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) study prospectively evaluated iodine-123 meta-iodobenzylguanidine (I-123-mIBG) imaging for identifying symptomatic heart failure (HF) patients most likely to experience cardiac events. Background Single-center studies have demonstrated the poorer prognosis of HF patients with reduced I-123-mIBG myocardial uptake, but these observations have not been validated in large multicenter trials. Methods A total of 961 subjects with New York Heart Association (NYHA) functional class II/III HF and left ventricular ejection fraction (LVEF) <= 35% were studied. Subjects underwent I-123-mIBG myocardial imaging (sympathetic neuronal integrity quantified as the heart/mediastinum uptake ratio [H/M] on 4-h delayed planar images) and myocardial perfusion imaging and were then followed up for up to 2 years. Time to first occurrence of NYHA functional class progression, potentially life-threatening arrhythmic event, or cardiac death was compared with H/M (either in relation to estimated lower limit of normal [1.60] or as a continuous variable) using Cox proportional hazards regression. Multivariable analyses using clinical, laboratory, and imaging data were also performed. Results A total of 237 subjects (25%) experienced events (median follow-up 17 months). The hazard ratio for H/M >= 1.60 was 0.40 (p < 0.001); the hazard ratio for continuous H/M was 0.22 (p < 0.001). Two-year event rate was 15% for H/M >= 1.60 and 37% for H/M <1.60; hazard ratios for individual event categories were as follows: HF progression, 0.49 (p = 0.002); arrhythmic events, 0.37 (p = 0.02); and cardiac death, 0.14 (p = 0.006). Significant contributors to the multivariable model were H/M, LVEF, B-type natriuretic peptide, and NYHA functional class. I-123-mIBG imaging also provided additional discrimination in analyses of interactions between B-type natriuretic peptide, LVEF, and H/M. Conclusions ADMIRE-HF provides prospective validation of the independent prognostic value of I-123-mIBG scintigraphy in assessment of patients with HF. (Meta-Iodobenzylguanidine Scintigraphy Imaging in Patients With Heart Failure and Control Subjects Without Cardiovascular Disease, NCT00126425; Meta-Iodobenzylguanidine [I-123-mIBG] Scintigraphy Imaging in Patients With Heart Failure and Control Subjects Without Cardiovascular Disease, NCT00126438) (J Am Coll Cardiol 2010;55:2212-21) (C) 2010 by the American College of Cardiology Foundation

【 授权许可】

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