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01-10-2013 | Original Article

Resting perfusion MPI-SPECT combined with cardiac ¹²³I-mIBG sympathetic innervation imaging improves prediction of arrhythmic events in non-ischemic cardiomyopathy patients: Sub-study from the ADMIRE-HF trial

Authors: Nitesh Sood, MD, Firas Al Badarin, MD, Matthew Parker, MD, Raja Pullatt, MD, Arnold F. Jacobson, MD, PhD, Timothy M. Bateman, MD, Gary V. Heller, MD, PhD

Published in: Journal of Nuclear Cardiology | Issue 5/2013

Abstract

Background

Delayed Iodine-123 meta-iodobenzylguanidine heart/mediastinum (H/M) uptake ratio predicted arrhythmic events in patients with heart failure (HF) and significant left ventricular dysfunction in ADMIRE-HF. We tested the hypothesis that resting perfusion defects on MPI-SPECT, representing scar, would further risk stratify patients beyond H/M ratio in the prediction of ventricular arrhythmic events in both ischemic (ICM) and non-ischemic cardiomyopathy (NICM) patients.

Methods

Patients from the ADMIRE-HF database were classified as ICM and NICM and were stratified by delayed H/M ratio (<1.6/≥1.6) and by summed rest score (SRS) (≤8/>8) on MPI-SPECT. The entire cohort was also classified as high risk (H/M <1.6, SRS >8) and low risk (H/M ≥1.6, SRS ≤8). Scores were from visual interpretation of individual and derived consensus (average) reads per ASNC guidelines.

Results

There were 612 (66%) ICM and 317 (34%) NICM patients. ICM patients had higher mean SRS than NICM patients (25 ± 13 vs 12 ± 10). Sixty-three arrhythmic events occurred over a median follow-up of 17 months. SRS had incremental predictive value among NICM patients with low H/M ratio (<1.6). There was no risk stratification in patients with ICM. Multivariable analysis for NICM with H/M ratio <1.6 demonstrated SRS score >8 as the only independent predictor of arrhythmic events (hazard ratio 3.3, 95% CI 1.1-9.8, P = .03). Patients classified in high-risk subgroup had statistically significant increased risk of arrhythmic events (hazard ratio 2.080, 95% CI 1.112-3.894, P = .022). There was only one event in low-risk subgroup with a trend towards lower risk of arrhythmic events (P = .07).

Conclusion

Resting perfusion defects provide independent risk stratification in addition to Iodine-123 meta-iodobenzylguanidine sympathetic innervation imaging in predicting arrhythmic events in patients with NICM and HF. High and potentially low-risk groups for arrhythmic events can be identified based on the severity of resting perfusion defect score and H/M ratio.

Stevenson WG, Stevenson LW, Middlekauff HR, Saxon LA. Sudden death prevention in patients with advanced ventricular dysfunction. Circulation 1993;88:2953-61.PubMedCrossRef

Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225-37.PubMedCrossRef

Kadish A, Dyer A, Daubert JP, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 2004;350:2151-8.PubMedCrossRef

Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008;51:e1-62.PubMedCrossRef

Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 2008;359:1009-17.PubMedCrossRef

Daubert JP, Zareba W, Cannom DS, et al. Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: Frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol 2008;51:1357-65.PubMedCrossRef

Carroll DL, Hamilton GA. Quality of life in implanted cardioverter defibrillator recipients: The impact of a device shock. Heart Lung 2005;34:169-78.PubMedCrossRef

Buxton AE, Lee KL, Hafley GE, et al. Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: Lessons from the MUSTT study. J Am Coll Cardiol 2007;50:1150-7.PubMedCrossRef

Jacobson AF, Senior R, Cerqueira MD, et al. 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. J Am Coll Cardiol 2010;55:2212-21.PubMedCrossRef

10.

Iles L, Pfluger H, Lefkovits L, et al. Myocardial fibrosis predicts appropriate device therapy in patients with implantable cardioverter-defibrillators for primary prevention of sudden cardiac death. J Am Coll Cardiol 2011;57:821-8.PubMedCrossRef

11.

van der Burg AE, Bax JJ, Boersma E, Pauwels EK, van der Wall EE, Schalij MJ. Impact of viability, ischemia, scar tissue, and revascularization on outcome after aborted sudden death. Circulation 2003;108:1954-9.PubMedCrossRef

12.

van den Heuvel AF, van Veldhuisen DJ, van der Wall EE, et al. Regional myocardial blood flow reserve impairment and metabolic changes suggesting myocardial ischemia in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol 2000;35:19-28.PubMedCrossRef

13.

Jacobson AF, Lombard J, Banerjee G, Camici PG. ¹²³I-mIBG scintigraphy to predict risk for adverse cardiac outcomes in heart failure patients: Design of two prospective multicenter international trials. J Nucl Cardiol 2009;16:113-21.PubMedCrossRef

14.

Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539-42.PubMedCrossRef

15.

Sharir T, Berman DS, Lewin HC, et al. Incremental prognostic value of rest-redistribution (201)Tl single-photon emission computed tomography. Circulation 1999;100:1964-70.PubMedCrossRef

16.

Dunn RF, Uren RF, Sadick N, et al. Comparison of thallium-201 scanning in idiopathic dilated cardiomyopathy and severe coronary artery disease. Circulation 1982;66:804-10.PubMedCrossRef

17.

Borges-Neto S, Shaw LK, Tuttle RH, et al. Incremental prognostic power of single-photon emission computed tomographic myocardial perfusion imaging in patients with known or suspected coronary artery disease. Am J Cardiol 2005;95:182-8.PubMedCrossRef

18.

Nishisato K, Hashimoto A, Nakata T, et al. Impaired cardiac sympathetic innervation and myocardial perfusion are related to lethal arrhythmia: Quantification of cardiac tracers in patients with ICDs. J Nucl Med 2010;51:1241-9.PubMedCrossRef

19.

Backs J, Haunstetter A, Gerber SH, et al. The neuronal norepinephrine transporter in experimental heart failure: Evidence for a posttranscriptional downregulation. J Mol Cell Cardiol 2001;33:461-72.PubMedCrossRef

20.

Brunner-La Rocca HP, Esler MD, Jennings GL, Kaye DM. Effect of cardiac sympathetic nervous activity on mode of death in congestive heart failure. Eur Heart J 2001;22:1136-43.PubMedCrossRef

21.

Danias PG, Ahlberg AW, Clark BA 3rd, et al. Combined assessment of myocardial perfusion and left ventricular function with exercise technetium-99m sestamibi gated single-photon emission computed tomography can differentiate between ischemic and nonischemic dilated cardiomyopathy. Am J Cardiol 1998;82:1253-8.PubMedCrossRef

22.

Pitcher D, Wainwright R, Maisey M, Curry P, Sowton E. Assessment of chest pain in hypertrophic cardiomyopathy using exercise thallium-201 myocardial scintigraphy. Br Heart J 1980;44:650-6.PubMedCrossRef

23.

Soman P, Lahiri A, Mieres JH, et al. Etiology and pathophysiology of new-onset heart failure: Evaluation by myocardial perfusion imaging. J Nucl Cardiol 2009;16:82-91.PubMedCrossRef

Title: Resting perfusion MPI-SPECT combined with cardiac 123I-mIBG sympathetic innervation imaging improves prediction of arrhythmic events in non-ischemic cardiomyopathy patients: Sub-study from the ADMIRE-HF trial
Authors: Nitesh Sood, MD
Firas Al Badarin, MD
Matthew Parker, MD
Raja Pullatt, MD
Arnold F. Jacobson, MD, PhD
Timothy M. Bateman, MD
Gary V. Heller, MD, PhD
Publication date: 01-10-2013
Publisher: Springer US
Published in: Journal of Nuclear Cardiology / Issue 5/2013
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-013-9750-y

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Resting perfusion MPI-SPECT combined with cardiac ¹²³I-mIBG sympathetic innervation imaging improves prediction of arrhythmic events in non-ischemic cardiomyopathy patients: Sub-study from the ADMIRE-HF trial

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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