Details

Autor(en) / Beteiligte

• Jain, Kaushik K., DO
• Hauptman, Paul J., MD
• Spertus, John A., MD, MPH
• Kennedy, Kevin F., MS
• Bateman, Timothy M., MD
• Jacobson, Arnold F., MD, PhD
• Stolker, Joshua M., MD

Titel

Incremental Utility of Iodine-123 Meta-Iodobenzylguanidine Imaging Beyond Established Heart Failure Risk Models

Ist Teil von

• Journal of cardiac failure, 2014-08, Vol.20 (8), p.577-583

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2014

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Background Nuclear myocardial imaging with iodine-123 meta-iodobenzylguanidine (123 I- m IBG) is approved for risk stratification of patients with systolic heart failure (HF). Whether123 I- m IBG imaging provides incremental prognostic utility beyond established risk models remains unclear. Methods and Results In a multicenter study, 961 patients with moderate systolic HF underwent123 I- m IBG imaging and were followed for cardiac death, progressive HF, or life-threatening arrhythmias over 2 years. We constructed 4 multivariable models, using variables from each of 4 published HF risk models, and patient-level scores were calculated both before and after adding the heart-to-mediastinum ratio (H/M) from123 I- m IBG imaging. Incremental utility was evaluated by calculating integrated discrimination improvement (IDI), which quantifies the increase in probability of experiencing the primary end point after adding H/M to each model. The composite end point occurred in 25% of patients. After adding H/M, absolute IDI ranged from 2.1% to 3.0%, representing 33%–59% relative improvements in risk stratification. Of note, hazard ratios for H/M were remarkably similar between risk models (0.40–0.44 for predicting the composite end point, 0.10–0.18 for mortality; all P < .001). Conclusions Despite notable differences in predictor variables, patient populations, and analytic techniques from which each model was initially derived, adding123 I- m IBG data to HF risk models consistently identified patients at lower risk of experiencing adverse events.