Denis Agostini1, Karthikeyan Ananthasubramaniam2, Harish Chandna3, Lars Friberg4, Andrew Hudnut5, Michael Koren6, Michael I Miyamoto7, Roxy Senior8, Mahesh Shah9, Mark I Travin10, Jürgen Vom Dahl11, Kun Chen12, Wayne C Levy13. 1. CHU Cote de Nacre, EA 4650, Normandy University, Caen, France. agostini-de@chu-caen.fr. 2. Henry Ford Health System, Detroit, MI, USA. 3. Victoria Heart and Vascular Center, Victoria, TX, USA. 4. Bispebjerg Hospital, Copenhagen, Denmark. 5. Sutter Institute for Medical Research, Sacramento, CA, USA. 6. Jacksonville Center for Clinical Research, Jacksonville, FL, USA. 7. Mission Heritage Medical Group, Mission Viejo, CA, USA. 8. National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital, London, UK. 9. Shah Associates MD, LLC, Prince Frederick, MD, USA. 10. Montefiore Medical Center, Bronx, NY, USA. 11. Kliniken Maria Hilf GmBH, Nordrhein-Westfalen, Germany. 12. GE Healthcare, Marlborough, MA, USA. 13. University of Washington, Seattle, WA, USA.
Abstract
BACKGROUND: To evaluate whether planar 123I-MIBG myocardial scintigraphy predicts risk of death in heart failure (HF) patients up to 5 years after imaging. METHODS AND RESULTS: Subjects from ADMIRE-HF were followed for approximately 5 years after imaging (964 subjects, median follow-up 62.7 months). Subjects were stratified according to the heart/mediastinum (H/M) ratio (< 1.60 vs ≥ 1.60) on planar 123I-MIBG scintigraphic images obtained at baseline in ADMIRE-HF. Cox proportional hazards models and Kaplan-Meier analyses were used to evaluate time to death, cardiac death, or arrhythmic events for subjects stratified by H/M ratio, baseline left ventricular ejection fraction (LVEF: < 25% and 25 to ≤ 35%), and by H/M strata within LVEF strata. All-cause mortality was 38.4% vs 20.9% and cardiac mortality was 16.8% vs 4.5%, in subjects with H/M < 1.60 vs ≥ 1.60, respectively (P < 0.05 for both comparisons). Subjects with preserved sympathetic innervation of the myocardium (H/M ≥ 1.60) were at significantly lower risk of all-cause and cardiac death, arrhythmic events, sudden cardiac death, or potentially life-threatening arrhythmias. Within LVEF strata, a trend toward a higher mortality for subjects with H/M < 1.60 was observed reaching significance for LVEF 25 to ≤ 35% only. CONCLUSIONS: During a median follow-up of 62.7 months, patients with H/M ≥ 1.60 were at significantly lower risk of death and arrhythmic events independently of LVEF values.
BACKGROUND: To evaluate whether planar 123I-MIBG myocardial scintigraphy predicts risk of death in heart failure (HF) patients up to 5 years after imaging. METHODS AND RESULTS: Subjects from ADMIRE-HF were followed for approximately 5 years after imaging (964 subjects, median follow-up 62.7 months). Subjects were stratified according to the heart/mediastinum (H/M) ratio (< 1.60 vs ≥ 1.60) on planar 123I-MIBG scintigraphic images obtained at baseline in ADMIRE-HF. Cox proportional hazards models and Kaplan-Meier analyses were used to evaluate time to death, cardiac death, or arrhythmic events for subjects stratified by H/M ratio, baseline left ventricular ejection fraction (LVEF: < 25% and 25 to ≤ 35%), and by H/M strata within LVEF strata. All-cause mortality was 38.4% vs 20.9% and cardiac mortality was 16.8% vs 4.5%, in subjects with H/M < 1.60 vs ≥ 1.60, respectively (P < 0.05 for both comparisons). Subjects with preserved sympathetic innervation of the myocardium (H/M ≥ 1.60) were at significantly lower risk of all-cause and cardiac death, arrhythmic events, sudden cardiac death, or potentially life-threatening arrhythmias. Within LVEF strata, a trend toward a higher mortality for subjects with H/M < 1.60 was observed reaching significance for LVEF 25 to ≤ 35% only. CONCLUSIONS: During a median follow-up of 62.7 months, patients with H/M ≥ 1.60 were at significantly lower risk of death and arrhythmic events independently of LVEF values.
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