This Article Figures Only Full Text Full Text (PDF) Online Appendix All Versions of this Article: j.jacc.2010.01.014v1 55/20/2212    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jacobson, A. F. Search for Related Content PubMed PubMed Citation Articles by Jacobson, A. F. Related Collections Related Articles

EXPEDITED PUBLICATION

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

Arnold F. Jacobson, MD, PhD^_*, Roxy Senior, MD, Manuel D. Cerqueira, MD, Nathan D. Wong, PhD, Gregory S. Thomas, MD, MPH, Victor A. Lopez, BS, Denis Agostini, MD, PhD^||, Fred Weiland, MD^¶, Harish Chandna, MD^#, Jagat Narula, MD, PhD^,_* ADMIRE-HF Investigators

^_* GE Healthcare, Princeton, New Jersey
Northwick Park Hospital, London, United Kingdom
Cleveland Clinic Foundation, Cleveland, Ohio
University of California, Irvine, California
^|| Centre Hospitalier Universitaire Cote de Nacre, Caen, France
^¶ Sutter Roseville Hospital, Roseville, California
^# Victoria Heart, Victoria, Texas

Manuscript received August 17, 2009; revised manuscript received January 19, 2010, accepted January 20, 2010.

^_* Reprint requests and correspondence: Dr. Jagat Narula, University of California at Irvine, 333 City Boulevard West, Suite 400, Orange, California 92868-4080 (Email: narula{at}uci.edu).

Objectives: The ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) study prospectively evaluated iodine-123 meta-iodobenzylguanidine (¹²³I-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 ¹²³I-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 ¹²³I-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. ¹²³I-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 ¹²³I-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)

Key Words: sympathetic nervous system • radionuclide imaging • heart failure • prognosis • cardiomyopathy • mIBG

Abbreviations and Acronyms   BNP = B-type natriuretic peptide   CE = cardiac event   HF = heart failure   H/M = heart/mediastinum ratio   ICD = implantable cardioverter-defibrillator   123I-mIBG = iodine-123 meta-iodobenzylguanidine   LVEF = left ventricular ejection fraction   MPI = myocardial perfusion imaging   NE = norepinephrine   NYHA = New York Heart Association   SCD = sudden cardiac death   SPECT = single-photon emission computed tomography   VT = ventricular tachycardia

Related Articles

Metaiodobenzylguanidine Imaging Comes of Age: A New Arrow in the Prognostic Quiver for Heart Failure Patients

H. William Strauss, Michelle N. Johnson, Heiko Schöder, and Nagara Tamaki
J. Am. Coll. Cardiol. 2010 55: 2222-2224. [Full Text] [PDF]

This article has been cited by other articles:

				O. Gaemperli, A. Saraste, and J. Knuuti Cardiac hybrid imaging Eur Heart J Cardiovasc Imaging, January 1, 2012; 13(1): 51 - 60. [Abstract] [Full Text] [PDF]

				G. M. Currie, B. Iqbal, J. M. Wheat, L. Wang, M. Trifunovic, H. F. Jelinek, and H. Kiat Risk Stratification in Heart Failure Using 123I-MIBG J. Nucl. Med. Technol., December 1, 2011; 39(4): 295 - 301. [Abstract] [Full Text] [PDF]

				P. Perrone-Filardi, S. Paolillo, S. Dellegrottaglie, P. Gargiulo, G. Savarese, C. Marciano, L. Casaretti, M. Cecere, F. Musella, E. Pirozzi, et al. Assessment of cardiac sympathetic activity by MIBG imaging in patients with heart failure: a clinical appraisal Heart, November 15, 2011; 97(22): 1828 - 1833. [Abstract] [Full Text] [PDF]

				M. Paul, T. Wichter, P. Kies, J. Gerss, C. Wollmann, K. Rahbar, L. Eckardt, G. Breithardt, O. Schober, E. Schulze-Bahr, et al. Cardiac Sympathetic Dysfunction in Genotyped Patients with Arrhythmogenic Right Ventricular Cardiomyopathy and Risk of Recurrent Ventricular Tachyarrhythmias J. Nucl. Med., October 1, 2011; 52(10): 1559 - 1565. [Abstract] [Full Text] [PDF]

				O. Gaemperli, F. M. Bengel, and P. A. Kaufmann Cardiac hybrid imaging Eur. Heart J., September 1, 2011; 32(17): 2100 - 2108. [Abstract] [Full Text] [PDF]

				F. M. Bengel Imaging Targets of the Sympathetic Nervous System of the Heart: Translational Considerations J. Nucl. Med., August 1, 2011; 52(8): 1167 - 1170. [Abstract] [Full Text] [PDF]

				A. J. Sinusas, J. D. Thomas, and G. Mills The Future of Molecular Imaging J. Am. Coll. Cardiol. Img., July 1, 2011; 4(7): 799 - 806. [Full Text] [PDF]

				M. Yu, J. Bozek, M. Lamoy, M. Guaraldi, P. Silva, M. Kagan, P. Yalamanchili, D. Onthank, M. Mistry, J. Lazewatsky, et al. Evaluation of LMI1195, a Novel 18F-Labeled Cardiac Neuronal PET Imaging Agent, in Cells and Animal Models Circ Cardiovasc Imaging, July 1, 2011; 4(4): 435 - 443. [Abstract] [Full Text] [PDF]

				D. B. Buxton, M. Antman, N. Danthi, V. Dilsizian, Z. A. Fayad, M. J. Garcia, M. R. Jaff, M. Klimas, P. Libby, M. Nahrendorf, et al. Report of the National Heart, Lung, and Blood Institute Working Group on the Translation of Cardiovascular Molecular Imaging Circulation, May 17, 2011; 123(19): 2157 - 2163. [Full Text] [PDF]

				R. J. Gibbons, P. A. Araoz, and E. E. Williamson The Year in Cardiac Imaging J. Am. Coll. Cardiol., April 26, 2011; 57(17): 1721 - 1734. [Full Text] [PDF]

				A. T. Owens and M. Jessup The Year in Heart Failure J. Am. Coll. Cardiol., April 12, 2011; 57(15): 1573 - 1583. [Full Text] [PDF]

				F. G. Hage and A. E. Iskandrian Cardiac Autonomic Denervation in Diabetes Mellitus Circ Cardiovasc Imaging, March 1, 2011; 4(2): 79 - 81. [Full Text] [PDF]

				M. C. Gerson, J. H. Caldwell, K. Ananthasubramaniam, I. P. Clements, M. J. Henzlova, A. Amanullah, and A. F. Jacobson Influence of Diabetes Mellitus on Prognostic Utility of Imaging of Myocardial Sympathetic Innervation in Heart Failure Patients Circ Cardiovasc Imaging, March 1, 2011; 4(2): 87 - 93. [Abstract] [Full Text] [PDF]

				I. Y. Chen and J. C. Wu Cardiovascular Molecular Imaging: Focus on Clinical Translation Circulation, February 1, 2011; 123(4): 425 - 443. [Full Text] [PDF]

				M. H. Crawford Does Cardiac Sympathetic Innervation Imaging Fulfill an Unmet Need for Managing Atrial Fibrillation? J. Am. Coll. Cardiol. Img., January 1, 2011; 4(1): 87 - 88. [Full Text] [PDF]

				M. J. Boogers and J. J. Bax Can cardiac [123I]m-iodobenzylguanidine imaging be used for risk stratification of patients with acute myocardial infarction? Heart, January 1, 2011; 97(1): 1 - 3. [Full Text] [PDF]

				S. Kasama, T. Toyama, H. Sumino, H. Kumakura, Y. Takayama, K. Minami, S. Ichikawa, N. Matsumoto, Y. Sato, and M. Kurabayashi Prognostic value of cardiac sympathetic nerve activity evaluated by [123I]m-iodobenzylguanidine imaging in patients with ST-segment elevation myocardial infarction Heart, January 1, 2011; 97(1): 20 - 26. [Abstract] [Full Text] [PDF]

				P. Bharadwaj and S. R. Underwood 20 Nuclear medicine in heart failure Oxford Textbook of Heart Failure, January 1, 2011; 1(1): med-9780199577729-chapter - med-9780199577729-chapter. [Abstract] [Full Text]

				B. Pitt New Opportunities and Challenges for Clinical Application of mIBG Imaging J. Am. Coll. Cardiol. Img., September 1, 2010; 3(9): 964 - 965. [Full Text] [PDF]

				I. Matsunari, J. Taki, K. Nakajima, and S. Kinuya 123I-Metaiodobenzylguanidine Imaging in the Era of Implantable Cardioverter Defibrillators: Beyond Ejection Fraction J. Nucl. Med., August 1, 2010; 51(8): 1171 - 1173. [Full Text] [PDF]

				H. W. Strauss, M. N. Johnson, H. Schoder, and N. Tamaki Metaiodobenzylguanidine Imaging Comes of Age: A New Arrow in the Prognostic Quiver for Heart Failure Patients J. Am. Coll. Cardiol., May 18, 2010; 55(20): 2222 - 2224. [Full Text] [PDF]