An (123)I-mIBG heart/mediastinum uptake ratio ≥1.60 was associated with a lower 2-year rate of cardiac events compared to a ratio <1.60 in heart failure patients (15% vs 37%; HR 0.40, P<0.001).
Cohort (n=961)
Yes
Does iodine-123 meta-iodobenzylguanidine imaging predict the composite of NYHA progression, arrhythmic events, or cardiac death in patients with NYHA class II/III heart failure and LVEF <=35%?
Iodine-123 meta-iodobenzylguanidine imaging provides independent prognostic value for predicting cardiac events in patients with symptomatic heart failure.
Hazard Ratio: 0.4
Absolute Event Rate: 15% vs 37%
p-value: p=<0.001
OBJECTIVES The ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) study prospectively evaluated iodine-123 meta-iodobenzylguanidine ((123)I-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 (123)I-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) or =1.60 was 0.40 (p or =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. (123)I-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 (123)I-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 123I-mIBG Scintigraphy Imaging in Patients With Heart Failure and Control Subjects Without Cardiovascular Disease, NCT00126438).
“Increased cardiac sympathetic activity is a prominent feature of heart failure and is associated with progressive deterioration and remodeling of the myocardium, inexorable decline in left ventricular function, and worsening symptoms. Our results suggest that in appropriately selected patients with heart failure, the 123I-mIBG imaging procedure can alert clinicians to the potential need for considering additional treatments.”
Jacobson et al. (Sat,) conducted a cohort in Heart Failure (n=961). Iodine-123 meta-iodobenzylguanidine ((123)I-mIBG) imaging (H/M ratio >=1.60) vs. H/M ratio <1.60 was evaluated on Time to first occurrence of NYHA functional class progression, potentially life-threatening arrhythmic event, or cardiac death (HR 0.40, p=<0.001). An (123)I-mIBG heart/mediastinum uptake ratio ≥1.60 was associated with a lower 2-year rate of cardiac events compared to a ratio <1.60 in heart failure patients (15% vs 37%; HR 0.40, P<0.001).