Abstract 519: Imaging of Myocardial Sympathetic Innervation for Prediction of Cardiac and All-cause Mortality in Heart Failure Patients: Analyses From the ADMIRE-HF Trial
Objectives ADMIRE-HF demonstrated significantly higher rates of heart failure (HF) progression, arrhythmic events, and cardiac death in HF subjects with reduced cardiac uptake of 123I-mIBG (4-hour heart/mediastinum ratio (H/M) <1.60). The present analyses examined the contribution of H/M to multivariate prediction models for cardiac and all-cause mortality.
Methods Of 961 NYHA class II (83%) and III (17%) HF (66% ischemic, 34% non-ischemic) subjects in ADMIRE-HF, 905 had complete clinical data and measurements of plasma NE and BNP. During median follow-up of 17 months, 75 of 905 subjects (8.3%) died; 51 deaths were adjudicated as cardiac and 24 as non-cardiac. Hazard ratios for cardiac and all-cause mortality were determined using multivariate Cox proportional hazards (CPH) analyses employing the following variables: age; gender; race (white/black/other); hypertension; dyslipidemia; smoking (current or past); diabetes; HF etiology; Body Mass Index; ACE inhibitor or angiotensin receptor blocker (ARB) use at baseline; beta blocker use at baseline; lipid lowering drug use at baseline; H/M; LVEF; NE; BNP; baseline NYHA class. Only variables with p-values <0.05 were retained in the final models.
Conclusions Three consistent contributors to prediction models of death in NYHA class II/III HF subjects with LVEF ≤35% were age, BNP, and H/M. LVEF contributed to prediction of cardiac death but not all-cause mortality. These results confirm that reduced myocardial sympathetic innervation on 123I-mIBG imaging is an independent predictor of mortality in HF subjects.