Incremental Utility of Iodine-123 Meta-Iodobenzylguanidine Imaging Beyond Established Heart Failure Risk Models

Jain, Kaushik K.; Hauptman, Paul J.; Spertus, John A.; Kennedy, Kevin F.; Bateman, Timothy M.; Jacobson, Arnold F.; Stolker, Joshua M.

doi:10.1016/j.cardfail.2014.06.001

Cited by 10 publications

(3 citation statements)

References 30 publications

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“…Recently, MIBG has emerged as an important tool in the risk stratification of patients with heart failure (HF) 2,3 The utility of the late heart to mediastinum ratio (HMR) as a prognostic indicator in HF was demonstrated in the ADMIRE-HF study in which a late HMR <1.6 was associated with an event rate of 37% over two years for HF progression, arrhythmia or death 4 . More recently combined analyses of several studies using MIBG have shown considerably improved risk stratification for events in patients with heart failure 5 , arrhythmic sudden cardiac death 6,7 , 5 year cardiac mortality 8 and long term prognosis 9 . In addition to measures of global innervation, single photon emission computed tomography (SPECT) derived innervation scores are predictive of ventricular arrhythmias and may be useful in the risk stratification of subjects undergoing implantable cardiac defibrillator implantation 10,11 .…”

Section: Introductionmentioning

confidence: 99%

Iodine-123 metaiodobenzylguanidine scintigraphy for the assessment of cardiac sympathetic innervation and the relationship with cardiac autonomic function in healthy adults using standardized methods

Asghar

Arumugam²,

Armstrong³

et al. 2017

Nuclear Medicine Communications

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Background Global 123I-mIBG (MIBG) uptake is predictive of cardiovascular events and mortality in subjects with heart failure (HF). Normal variations in global and regional uptake however, are not well defined and few studies have addressed the functional relevance of MIBG uptake and distribution in healthy subjects. Methods and Results We undertook MIBG scintigraphy and cardiac autonomic function testing using standardized methodology in 15 healthy subjects (mean age 54.6±5.3 years, M:F 10:5) with no evidence of previous MI or ischaemic heart disease (IHD). Early heart to mediastinum ratio (HMR) was 1.67±0.13, late HMR 1.73±0.16 and washout rate (WR) 19.09±7.63% (4.20–31.30). Regional analysis revealed reduced tracer uptake at the apex, base and inferior wall in all subjects. Early and late HMR correlated negatively with RFa (r=−0.603; p=0.05 and −0.644; p=0.033) and E/I ratio (r=−0.616; p=0.043 and −0.676; p=0.022) and positively with LFa/RFa (r=0.711; p=0.014 and 0.784; p=0.004). WR correlated only with RFa (r=0.642, p=0.033). Conclusion Healthy adults demonstrate a heterogeneous pattern of cardiac innervation with reduced regional uptake of MIBG. Furthermore, HMR correlates with indices of cardiac sympathetic function, suggesting that it might not only be a useful prognostic marker but may also provide insight into the functional integrity of the cardiac autonomic nervous system.

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Section: Introductionmentioning

confidence: 99%

Iodine-123 metaiodobenzylguanidine scintigraphy for the assessment of cardiac sympathetic innervation and the relationship with cardiac autonomic function in healthy adults using standardized methods

Asghar

Arumugam²,

Armstrong³

et al. 2017

Nuclear Medicine Communications

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“…Patients in ADMIRE-HF with an H / M ratio ≥1.6 had significantly reduced risks of a cardiac event [hazard ratio (HR) 0.40, P < 0.001], HF progression (HR 0.49; P = 0.002), potentially life-threatening arrhythmia (HR 0.37; P = 0.020), and cardiac death (HR 0.14; P = 0.006) in comparison with patients with an H / M ratio <1.6 [ 11 ]. The addition of I- m IBG to a number of multivariable risk models, including the Seattle Heart Failure Model, was found to improve risk stratification in comparison with the risk models alone [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Iodine-123 Meta-Iodobenzylguanidine Imaging for Screening Heart Failure Patients Eligible for an Implantable Cardioverter Defibrillator in the USA

O’Day

Levy

Johnson³

et al. 2016

Appl Health Econ Health Policy

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BackgroundMany guideline-eligible heart failure (HF) patients do not receive a survival benefit from implantable cardioverter defibrillators (ICDs). Improved risk stratification may help to reduce costs and improve the cost effectiveness of ICDs.ObjectiveTo estimate the potential outcomes, costs, and cost effectiveness of using iodine-123 meta-iodobenzylguanidine (I-mIBG) to screen HF patients eligible for an ICD.MethodsA decision-analytic model was developed to compare screening with I-mIBG imaging and no screening over 2-year and 10-year time horizons from a US payer perspective. Data on I-mIBG imaging and risk stratification were obtained from the ADMIRE-HF/HFX (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) trial. Data on ICD effectiveness for prevention of sudden cardiac death (SCD) were obtained from a meta-analysis. Costs of ICDs and costs of generator and lead procedures were obtained from the Agency for Healthcare Research and Quality National Inpatient Sample. Age-specific mortality was modeled using US life tables and data from the ACT (Advancements in ICD Therapy) Registry on risks of SCD and non-SCD mortality. Sensitivity analyses were conducted.ResultsIn the analysis, screening with I-mIBG imaging was associated with a reduction in ICD utilization of 21 %, resulting in a number needed to screen to prevent 1 ICD implantation of 5. Screening reduced the costs per patient by US$5500 and US$13,431 (in 2013 dollars) over 2 and 10 years, respectively, in comparison with no screening and resulted in losses of 0.001 and 0.040 life-years, respectively, over 2 and 10 years. Screening was decrementally cost effective, with savings of US$5,248,404 and US$513,036 per quality-adjusted life-year lost over 2 and 10 years, respectively. In subgroup analyses, cost savings were greater for patients with an ejection fraction (EF) of 25–35 % than for those with an EF <25 %.ConclusionsAccording to the model, screening of guideline-eligible patients selected for ICDs with I-mIBG imaging may be cost effective and may help reduce costs associated with implantation of ICDs, with a minimal impact on survival.

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“…Additionally, due to the non-invasive technique of these imaging tools, their model and imaging approach can provide a means to evaluate the progression of HF and to quantify the temporal changes in flow and metabolism. In addition to the information provided on perfusion and metabolic outcomes, additional imaging could be applied to interrogate regional activation of critical receptors or enzymes within the myocardium, [24][25][26][27][28] neurohormonal changes, [29][30][31][32][33] along with regional changes in myocardial hypoxia, 34 apoptosis, 35,36 necrosis, 37 and fibrosis. 38 Unfortunately, the current study reported a high attrition (overall survival rate of 26%) with a major cause of death attributable to lethal arrhythmias during the perioperative period.…”

Section: See Related Article Pp 655-665mentioning

confidence: 99%

Creation of clinically relevant model of chronic heart failure: Application of multi-modality imaging to define physiology

Thorn

Sinusas

2015

Journal of Nuclear Cardiology

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Incremental Utility of Iodine-123 Meta-Iodobenzylguanidine Imaging Beyond Established Heart Failure Risk Models

Cited by 10 publications

References 30 publications

Iodine-123 metaiodobenzylguanidine scintigraphy for the assessment of cardiac sympathetic innervation and the relationship with cardiac autonomic function in healthy adults using standardized methods

Iodine-123 metaiodobenzylguanidine scintigraphy for the assessment of cardiac sympathetic innervation and the relationship with cardiac autonomic function in healthy adults using standardized methods

Cost-Effectiveness Analysis of Iodine-123 Meta-Iodobenzylguanidine Imaging for Screening Heart Failure Patients Eligible for an Implantable Cardioverter Defibrillator in the USA

Creation of clinically relevant model of chronic heart failure: Application of multi-modality imaging to define physiology

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