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| |  Imaging Helps Assess Arrhythmia and Cardiac Death Risk in Patients With Heart Failure: Presented at AHA By Bruce Sylvester ORLANDO, Fla -- November 19, 2009 -- Imaging of the cardiac sympathetic nerves could be helpful to clinicians in assessing risk of cardiac arrhythmias and cardiac death in patients with heart failure (HF), according to a study presented here on November 17 at the American Heart Association (AHA) Scientific Sessions 2009. Results of the AdreView Myocardial Imaging for Risk Evaluation in Heart Failure (ADMIRE-HF) trial have already shown significantly higher rates of HF progression, arrhythmic events, and cardiac death in patients with reduced cardiac uptake of myocardial iodine-123-metaiodobenzylguanidine (123I-mIBG, 4-hour heart/mediastinum ratio [H/M] <1.60). In this follow-up to ADMIRE-HF, the investigators examined the extension study data for any relationships between H/M ratio and cardiac and all-cause mortality. They reported that cardiac imaging with iobenguane I-123 is capable of identifying extremely low 2-year risk of fatal arrhythmic events and a higher than average likelihood of fatal and non-fatal arrhythmias in New York Heart Association (NYHA) class 2 and 3 heart failure patients. “We found that reduced myocardial sympathetic innervation on 123I-mIBG imaging is a strong and independent predictor of mortality in patients with advanced congestive heart failure,” said lead investigator and presenter Mark Travin, MD, CV Nuclear Medicine, Montefiore Medical Center, and Albert Einstein College of Medicine, Bronx, New York. Of 961 NYHA class 2 (83%) and 3 (17%) HF patients (66% ischaemic, 34% non-ischaemic) in ADMIRE-HF, investigators were able to study complete clinical data and measurements of plasma norepinephrine (NE) and B-type natriuretic peptide (BNP) for 905 individuals. During a median follow-up of 17 months, 75 of 905 (8.3%) patients died; 51 of these deaths were cardiac and 24 were non-cardiac (cancer, 5; pneumonia, 4; chronic obstructive pulmonary disease, 3; cerebrovascular accident, 3; accidents, 3; renal failure, 2; seizure, 1; subarachnoid haemorrhage, 1; sepsis, 1; and undetermined, 1) The investigators used standard statistical tools to analyse the 17-month data for cardiac and all-cause mortality related to other factors such as age, gender, race, hypertension, dyslipidaemia, smoking status, diabetes, heart failure etiology, H/M, left ventricular ejection fraction (LVEF), BNP, and baseline NYHA class. Statistically significant relationships were found between cardiac mortality and H/M (P = .046), LVEF (P = .004), BNP (P < .001), and age (P = .013). They also observed statistically significant relationships between all-cause mortality and H/M (P = .011), BNP (P < .001), and age (P = .001). Dr. Travin noted that LVEF <=30% and BNP >=300 ng/L had no cardiac deaths when H/M was >=1.6. Funding for this study was provided by GE Healthcare. [Presentation title: Imaging of Myocardial Sympathetic Innervation for Prediction of Cardiac and All-Cause Mortality in Heart Failure Patients: Analyses From the ADMIRE-HF Trial. Abstract 519]
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