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心肌碘-123 间碘苄胍显像与心力衰竭中的心脏事件。前瞻性 ADMIRE-HF（AdreView 心肌成像用于心力衰竭风险评估）研究的结果。

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.

机构信息

GE Healthcare, Princeton, New Jersey, USA.

出版信息

J Am Coll Cardiol. 2010 May 18;55(20):2212-21. doi: 10.1016/j.jacc.2010.01.014. Epub 2010 Feb 25.

DOI:10.1016/j.jacc.2010.01.014

PMID:20188504

Abstract

OBJECTIVES

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.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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).

摘要

目的

ADMIRE-HF（AdreView 心肌成像在心力衰竭风险评估中的应用）研究前瞻性评估碘-123 间碘苄胍 ((123)I-mIBG) 成像，以识别最有可能发生心脏事件的有症状心力衰竭 (HF) 患者。

背景

单中心研究表明，（123）I-mIBG 心肌摄取减少的 HF 患者预后较差，但这些观察结果尚未在大型多中心试验中得到验证。

方法

共纳入 961 例纽约心脏协会 (NYHA) 心功能 II/III 级 HF 和左心室射血分数 (LVEF) <或=35%的患者。患者接受（123）I-mIBG 心肌成像（4 小时延迟平面图像上的心脏/纵隔摄取比 [H/M] 定量测定交感神经完整性）和心肌灌注成像，然后进行长达 2 年的随访。使用 Cox 比例风险回归比较首次出现 NYHA 心功能分级进展、潜在危及生命的心律失常事件或心脏死亡的时间与 H/M（与估计的正常值下限 [1.60] 相关或作为连续变量）。还使用临床、实验室和成像数据进行多变量分析。

结果

共有 237 例患者（25%）发生事件（中位随访时间 17 个月）。H/M >或=1.60 的风险比为 0.40（p < 0.001）；H/M 连续变量的风险比为 0.22（p < 0.001）。H/M >或=1.60 的 2 年事件发生率为 15%，H/M <1.60 的为 37%；各事件类别的风险比如下：HF 进展，0.49（p = 0.002）；心律失常事件，0.37（p = 0.02）；心脏死亡，0.14（p = 0.006）。多变量模型中的重要贡献因素是 H/M、LVEF、B 型利钠肽和 NYHA 心功能分级。（123）I-mIBG 成像还提供了 B 型利钠肽、LVEF 和 H/M 之间相互作用分析的额外区分度。