¹²³I-MIBG Imaging for Prediction of Mortality and Potentially Fatal Events in Heart Failure: The ADMIRE-HFX Study

Abstract

ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) established the prognostic significance of 123 Imetaiodobenzylguanidine ( 123 I-MIBG) imaging in heart failure subjects (median follow-up, 17 mo) using a composite endpoint dominated by heart failure progression. The ADMIRE-HF extension (ADMIRE-HFX) extended follow-up to a median of 24 mo and used mortality as the primary endpoint. The objective of these analyses was to use multiple multivariate risk modeling techniques to determine the independent predictive ability of 123 I-MIBG imaging for mortality outcomes. Methods: Data from 964 New York Heart Association class II-III subjects in ADMIRE-HFX were included. All-cause mortality and a composite endpoint of death or death-equivalent events (resuscitated arrest, successful defibrillation for ventricular tachycardia or ventricular fibrillation) were analyzed with multivariate Cox proportional hazards and logistic regression techniques using demographic and clinical variables and the 123 I-MIBG heartto-mediastinum ratio (H/M). The incremental value of H/M was also examined for the logistic regression models using receiveroperating-characteristic curve methods and for the proportional hazards models using net reclassification improvement. Results: There were 101 deaths, and 136 subjects had a composite event during follow-up. H/M was significant in all multivariate proportional hazards and logistic regression models for the 2 mortality endpoints, both models developed with only clinical variables and those including left ventricular ejection fraction and b-type natriuretic peptide (BNP). For baseline models including BNP, the addition of H/M did not significantly increase receiver-operating-characteristic curve area. However, there was significant net reclassification improvement with the addition of H/M to a proportional hazards model containing BNP and left ventricular ejection fraction. Conclusion: The multivariate Cox proportional hazards and logistic regression analyses demonstrated consistent significance for H/M when added to the baseline risk models for mortality and mortality-equivalent events.

Beta blocker dose and markers of sympathetic activation in heart failure patients: interrelationships and prognostic significance

“…In light of the results from SHIFT and these other analyses, the paradigm of aiming for the highest tolerated dose of beta blocker may need to be shifted to aiming for a lower heart rate. This concept clearly warrants further prospective study.None of the studies mentioned previously assessed the prognostic value of cardiac 123 I‐ m IBG uptake, a measurement that has repeatedly been shown to be predictive 18, 25, 26, 27, 28, 29. The present study demonstrated the potential value of cardiac 123 I‐ m IBG uptake as a supplementary measure of sympathetic nervous system activity.…”

Recent Advances in Biomarker Discovery — from Serum to Imaging-based Biomarkers for a Complex Assessment of Heart Failure Patients

“…47 Several studies suggested new imaging-based biomarkers to assess the ventricular functions, such as late heartto-mediastinum ratio (HMR) during cardiac metaiodobenzylguanidine (MIBG) imaging in the ADRECARD study, or (123)I-metaiodobenzylguanidine ((123)I-MIBG) imaging in the ADMIRE-HF study (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure). 48,49 The potential role of CMR-derived T1 mapping in evaluating myocardial fibrosis was demonstrated by several studies, which showed that this new biomarker can independently predict invasively measured LV stiffness. 50 …”

Ventricular arrhythmias and autonomic nervous system: evolving role of radionuclide imaging

“…These patients however composed only 5% of the study population. 19,20 Highest frequency of arrhythmic events occurred in patients with H/M ratio between 1.3 and 1.39. Patients with lower H/ M ratio did have higher mortality, suggesting the higher prevalence of non-arrhythmic causes of death, like pump failure and non-cardiac causes.…”