Abstract 511: Influence of Diabetes Mellitus on Prognostic Utility of Imaging of Myocardial Sympathetic Innervation in Heart Failure Patients: Further Observations From ADMIRE-HF
Objectives Diabetic autonomic neuropathy can result in reduced cardiac uptake of 123I-mIBG. The present analyses examined whether diabetes mellitus (DM) influenced the prognostic results in the recently completed ADMIRE-HF trial.
Methods 961 subjects with NYHA class II (83%) and III (17%) heart failure (HF) (66% ischemic, 34% non-ischemic) and LVEF≤35% (mean 27%; median 29%) underwent 4-hour planar 123I-mIBG imaging for determination of heart/mediastinum ratio (H/M) and were followed for a maximum of 2 years. The composite primary endpoint consisted of HF progression, non-fatal arrhythmic events (self-limited sustained VT, aborted cardiac arrest, appropriate ICD discharge), and cardiac death. The study included 343 subjects (36%) with DM. H/M results for DM and non-DM subjects with and without primary outcome events were compared using t-tests and multivariate Cox proportional hazards (CPH) analyses.
Results During a median follow-up of 17 months, 237 subjects (25%) experienced a primary outcome event. The proportion of DM subjects with events (98/343; 28.6%) was significantly higher than for non-DM (139/618; 22.5%) (p<0.05). DM subjects had significantly lower cardiac 123I-mIBG uptake than non-diabetic subjects (Mean H/M 1.39±0.19 vs 1.47±0.21; p<0.001). 123I-mIBG imaging results in relation to occurrence of outcome events are summarized in the table⇓. In the CPH analyses, DM was a significant contributor to the risk for HF progression (hazard ratio 1.42 (p = 0.03)), but not for the composite endpoint or for arrhythmic events or cardiac death.
Conclusions DM subjects had lower cardiac 123I-mIBG uptake than non-DMs, and those who experienced outcome events had lower uptake than those who did not. Presence of DM did not adversely affect the prognostic capability of cardiac 123I-mIBG imaging results. When 123I-mIBG results are included, presence of DM is an independent predictor of risk for HF progression but not for risk of arrhythmic events or cardiac death.