title: Persistence of123I-mIBG Prognostic Capability in Relation to Medical Therapy in Heart Failure (from the ADMIRE-HF Trial).
abstract: 123I-mIBG imaging has been evaluated to assess sympathetic function and prognosis in heart failure (HF). However, the effect of combined HF medical therapies on123I-mIBG uptake and its prognostic significance has not been previously examined. This analysis examined the relation between the intensity of guideline-directed HF medical therapy and global123I-mIBG cardiac uptake in the AdreView Myocardial Imaging for Risk Evaluation in Heart Failure (ADMIRE-HF) database. A second objective was to investigate whether this guideline-based therapy, measured by total medication doses, had the expected effect on outcome, that is, that patients with higher123I-mIBG cardiac uptake and more intensive medical therapy had the fewest outcome events. Three HF cardiologists developed an HF Medication Score (HFMS) to quantify adequacy of dosages of β blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers and mineralocorticoid receptor antagonists. A Cox model was used to investigate the predictive ability of the HFMS for mortality events during median 17 months follow-up. Multiple regression and Cox models assessed the usefulness of the HFMS relative to the planar heart/mediastinum ratio (H/Mp) from123I-mIBG imaging in prediction of an event and to characterize the interaction of HFMS and H/M in predicting an event. HFMS was not a significant predictor of all-cause or cardiac death in either univariate or multivariate Cox models; H/Mp was highly significant for both event categories (p <0.0001). Mean H/Mp did not differ among HFMS ranges 0 to 3, 4 to 6, and 7 to 9. However, within each category, the mean H/Mp for subjects with events was significantly lower than that of subjects without events, with the exception of cardiac mortality in those with highest scores. In conclusion, intensity of medical therapy is not predictive of short-term mortality in HF patients. H/Mp is a good predictor for both cardiac and overall mortality regardless of medical therapy levels.
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Montefiore-Einstein, Bronx, New York. Electronic address: ilpina@montefiore.org.
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.affiliation: Department of Medicine, Washington DC Veterans Affairs Medical Center, Washington, DC.
authors.forename: Peter
authors.initials: P
authors.lastname: Carson
authors.affiliation: Department of Medicine, Vanderbilt Heart and Lung Institute Medical Center East, Nashville, Tennessee.
authors.forename: JoAnn
authors.initials: J
authors.lastname: Lindenfeld
authors.affiliation: Virtu Stat, Ltd., North Wales, Pennsylvania.
authors.forename: W Tad
authors.initials: WT
authors.lastname: Archambault
authors.affiliation: Diagram Consulting, Kihei, Hawaii.
authors.forename: Arnold F
authors.initials: AF
authors.lastname: Jacobson
mesh_terms: D019797:3-Iodobenzylguanidine; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D019275:Radiopharmaceuticals; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine