Persistence of123 I- m IBG Prognostic Capability in Relation to Medical Therapy in Heart Failure (From the ADMIRE-HF Trial)

Abstract123 I- m IBG imaging has been evaluated to assess sympathetic function and prognosis in heart failure (HF). However, the effect of combined HF medical therapies on123 I- m IBG uptake and its prognostic significance has not been previously examined. This analysis examined the relationship between the intensity of Guideline-Directed HF medical therapy (GDMT) and global123 I- m IBG cardiac uptake in the ADMIRE-HF database. A second objective was to investigate whether this guideline-based therapy, measured by total medication doses, had the expected effect on outcome, i.e., that patients with higher123 I- m IBG cardiac uptake and more intensive medical therapy had the fewest outcome events. Three HF cardiologists developed a HF Medication Score (HFMS) to quantify adequacy of dosages of beta blockers, ACE inhibitors and ARBs, and mineralocorticoid receptor antagonists (MRA). A Cox model was used to investigate the predictive ability of the HFMS for mortality events during median 17 months follow-up. Multiple regression and Cox models assessed the usefulness of the HFMS relative to the planar heart/mediastinum ratio (H/Mp) from123 I- m IBG imaging in prediction of an event and to characterize the interaction of HFMS and H/M in predicting an event. HFMS was not a significant predictor of all-cause or cardiac death in either univariate or multivariate Cox models; H/Mp was highly significant for both event categories (p < 0.0001). Mean H/Mp did not differ among HFMS ranges 0-3, 4-6, and 7-9. However, within each category, the mean H/Mp for subjects with events was significantly lower than that of subjects without events, with the exception of cardiac mortality in those with highest scores. In conclusion: Intensity of medical therapy is not predictive of short-term mortality in HF patients. H/Mp is a good predictor for both cardiac and overall mortality regardless of medical therapy levels.