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.
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.
A total of 961 subjects with New York Heart Association (NYHA) functional class II/III
HF and left ventricular ejection fraction (LVEF) < or =35% were studied. Subjects
underwent (123)I-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.
A total of 237 subjects (25%) experienced events (median follow-up 17 months). The
hazard ratio for H/M > or =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 > 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.
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).