Myocardial Iodine-123 Meta-Iodobenzylguanidine Imaging and Cardiac Events in Heart Failure

Jacobson, Arnold F.; Senior, Roxy; Cerqueira, Manuel D.; Wong, Nathan D.; Thomas, Gregory S.; López, Víctor A.; Denis, Arnaud; Weiland, Frederick L.; Chandna, Harish; Narula, Jagat; Investigators, Admire-Hf

doi:10.1016/j.jacc.2010.01.014

Cited by 772 publications

(267 citation statements)

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“…In light of the results from SHIFT and these other analyses, the paradigm of aiming for the highest tolerated dose of beta blocker may need to be shifted to aiming for a lower heart rate. This concept clearly warrants further prospective study.None of the studies mentioned previously assessed the prognostic value of cardiac 123 I‐ m IBG uptake, a measurement that has repeatedly been shown to be predictive 18, 25, 26, 27, 28, 29. The present study demonstrated the potential value of cardiac 123 I‐ m IBG uptake as a supplementary measure of sympathetic nervous system activity.…”

Section: Discussionmentioning

confidence: 52%

“…In previous ADMIRE‐HF multivariate analyses for predictors of death, use of HF medications (angiotensin converting enzyme inhibitors/angiotensin receptor blockers, beta blockers, and aldosterone receptor antagonists) did not affect the final models 18, 29. To examine for interactions between HF medications and the four variables used in the present study, mortality analyses were performed first without and then with inclusion of binary variables of use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers, aldosterone receptor antagonists, and diuretics.…”

Section: Resultsmentioning

confidence: 90%

“…This was a post hoc analysis of ADMIRE‐HF data; main study results have been published 18. In brief, ADMIRE‐HF enrolled 985 stable (no recent hospitalization or cardiac procedures within 30 days) HF patients [New York Heart Association (NYHA) class II/III] with left ventricular ejection fraction (LVEF) ≤35%.…”

Section: Methodsmentioning

confidence: 99%

“…Adjudication of events was performed as previously described 18. All deaths were categorized as either cardiac or non‐cardiac in origin.…”

Section: Methodsmentioning

confidence: 99%

“…Multivariable analysis did not include other known potent prognostic variables in HF such as age, BNP, left ventricular ejection fraction, and diuretic dose because our aim was not to add another prognostic model in HF to the long list of existing ones, but to specifically address the question of the relative prognostic potency of various markers related to adrenergic tone. Extensive multivariable analyses of the data from ADMIRE‐HF, including clinical characteristics, medical history, and medication usage, have been published 18, 29, 30. In separate analyses including age (a demonstrated prognostc factor for death in ADMIRE‐HF29) and loop diuretic dose (a significant factor for mortality prediction using the Seattle HF model30), H/M and norepinephrine level remained powerful prognostic factors for mortality (data not shown).…”

Section: Limitationsmentioning

confidence: 99%

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Beta blocker dose and markers of sympathetic activation in heart failure patients: interrelationships and prognostic significance

2017

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AimsExtent of cardiac sympathetic activation can be estimated from physiological parameters, blood biomarkers, and imaging findings. This study examined the prognostic value of three markers of sympathetic activity and their relationship to beta blocker dose in heart failure patients.Methods and resultsA post hoc analysis of 858 heart failure subjects in the ADMIRE‐HF trial was performed. Variables related to sympathetic activity were plasma norepinephrine, baseline heart rate, the heart to mediastinum (H/M) ratio of 123I‐mIBG uptake, and beta blocker dose. Univariate and multivariate analyses for occurrence of mortality (all‐cause and cardiac) and arrhythmic events were performed. Beta blocker dose was significantly related to age, heart rate, b‐type natriuretic peptide (negatively), body mass index, body weight and plasma norepinephrine. Univariate predictors of all‐cause and cardiac mortality were baseline heart rate (χ 2 = 4.5, P = 0.029 and χ 2 = 5 .2, P = 0.022, respectively), plasma norepinephrine level (χ 2 = 8.9, P = 0.0006 and χ 2 = 8.6, P = 0.003, respectively), and H/M (χ = 22.4, P < 0.0001 and χ 2 = 17.8, P < 0.0001, respectively). In multivariate analyses, carvedilol‐equivalent dose (P = 0.017), plasma norepinephrine (P = 0.002), and H/M (P = 0.0001) were significant predictors of all‐cause mortality. In separate analyses using multiple measurements of heart rate, mean heart rate >67 b.p.m. was associated with significantly higher cardiac mortality.ConclusionsHigher beta blocker dose was associated with lower mortality, but of the variables associated with sympathetic activity examined, cardiac 123I‐mIBG uptake was the most powerful prognostic marker in heart failure patients. Elevated heart rate was associated with greater risk for cardiac death.

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Section: Discussionmentioning

confidence: 52%

Section: Resultsmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

“…Adjudication of events was performed as previously described 18. All deaths were categorized as either cardiac or non‐cardiac in origin.…”

Section: Methodsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Beta blocker dose and markers of sympathetic activation in heart failure patients: interrelationships and prognostic significance

2017

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Coronary Sinus Neuropeptide Y Levels and Adverse Outcomes in Patients With Stable Chronic Heart Failure

et al. 2020

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IMPORTANCE Chronic heart failure (CHF) is associated with increased sympathetic drive and may increase expression of the cotransmitter neuropeptide Y (NPY) within sympathetic neurons. OBJECTIVE To determine whether myocardial NPY levels are associated with outcomes in patients with stable CHF. DESIGN, SETTING, AND PARTICIPANTS Prospective observational cohort study conducted at a single-center, tertiary care hospital. Stable patients with heart failure undergoing elective cardiac resynchronization therapy device implantation between 2013 and 2015. MAIN OUTCOMES AND MEASURES Chronic heart failure hospitalization, death, orthotopic heart transplantation, and ventricular assist device placement. RESULTS Coronary sinus (CS) blood samples were obtained during cardiac resynchronization therapy (CRT) device implantation in 105 patients (mean [SD] age 68 [12] years; 82 men [78%]; mean [SD] left ventricular ejection fraction [LVEF] 26% [7%]). Clinical, laboratory, and outcome data were collected prospectively. Stellate ganglia (SG) were collected from patients with CHF and control organ donors for molecular analysis. Mean (SD) CS NPY levels were 85.1 (31) pg/mL. On bivariate analyses, CS NPY levels were associated with estimated glomerular filtration rate (eGFR; r s = −0.36, P < .001); N-terminal-pro hormone brain natriuretic peptide (r s = 0.33; P = .004), and LV diastolic dimension (r s = −0.35; P < .001), but not age, LVEF, functional status, or CRT response. Adjusting for GFR, age, and LVEF, the hazard ratio for event-free (death, cardiac transplant, or left ventricular assist device) survival for CS NPY Ն 130 pg/mL was 9.5 (95% CI, 2.92-30.5; P < .001). Immunohistochemistry demonstrated significantly reduced NPY protein (mean [SD], 13.7 [7.6] in the cardiomyopathy group vs 31.4 [3.7] in the control group; P < .001) in SG neurons from patients with CHF while quantitative polymerase chain reaction demonstrated similar mRNA levels compared with control individuals, suggesting increased release from SG neurons in patients with CHF. CONCLUSIONS AND RELEVANCE The CS levels of NPY may be associated with outcomes in patients with stable CHF undergoing CRT irrespective of CRT response. Increased neuronal traffic and release may be the mechanism for elevated CS NPY levels in patients with CHF. Further studies are warranted to confirm these findings.

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Towards Non‐invasive Mapping and Imaging of Cardiac Arrhythmias

Delgado

Bertini²,

Bax

2012

Cardiac Mapping

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Myocardial Iodine-123 Meta-Iodobenzylguanidine Imaging and Cardiac Events in Heart Failure

Cited by 772 publications

References 24 publications

Beta blocker dose and markers of sympathetic activation in heart failure patients: interrelationships and prognostic significance

Beta blocker dose and markers of sympathetic activation in heart failure patients: interrelationships and prognostic significance

Coronary Sinus Neuropeptide Y Levels and Adverse Outcomes in Patients With Stable Chronic Heart Failure

Towards Non‐invasive Mapping and Imaging of Cardiac Arrhythmias

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