Relationship of technetium-99m tetrofosmin-gated rest single-photon emission computed tomography myocardial perfusion imaging to death and hospitalization in heart failure patients: results from the nuclear ancillary study of the HF-ACTION trial - 06/08/11

Doi : 10.1016/j.ahj.2011.02.007

Allen E. Atchley, MD ^a,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Ami E. Iskandrian, MD ^b,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Dan Bensimhon, MD ^a,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Stephen J. Ellis, PhD ^a,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Dalane W. Kitzman, MD ^c,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Linda K. Shaw, MS ^a,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Robert A. Pagnanelli, NCT ^a,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, David J. Whellan, MD ^d,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Julius M. Gardin, MD ^e,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Andrew Kao, MD ^f,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Khaled Abdul-Nour, MD ^g,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Greg Ewald, MD ^h,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Mary Norine Walsh, MD ^i,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, William E. Kraus, MD ^a,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Christopher M. O'Connor, MD ^a,^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}, Salvador Borges-Neto, MD ^a,^{^⁎,}^{^{j
On behalf of the HF-ACTION Trial Nuclear Ancillary Study Investigators.}}
^a Duke University Medical Center, Durham, NC
^b University of Alabama at Birmingham, Birmingham, AL
^c Wake Forest University School of Medicine, Winston-Salem, NC
^d Jefferson Medical College, Philadelphia, PA
^e Hackensack University Medical Center, Hackensack, NJ
^f Mid-America Heart Institute, Kansas City, MO
^g Henry Ford Hospital, Detroit, MI
^h Washington University, St. Louis, MO
ⁱ Saint Vincent Hospital, Indianapolis, IN

^⁎Reprint requests: Salvador Borges-Neto, MD, Department of Medicine and Radiology, Duke University Medical Center, Durham, NC27710.

Riassunto

Background

We hypothesized that the severity of resting perfusion abnormalities assessed by the summed rest score (SRS) would be associated with a higher rate of adverse outcomes in patients with heart failure (HF) and reduced left ventricular (LV) ejection fraction (EF).

Methods

A subset of 240 subjects from HF-ACTION underwent resting technetium-99m tetrofosmin-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Images were evaluated using a 17-segment model to derive the SRS and additional nuclear variables.

Results

After adjusting for prespecified covariates, SRS was significantly associated with the primary end point (hazard ratio 0.98, 95% confidence interval [CI] 0.97-1.00, P = .04), with a higher SRS corresponding to lower risk of an event. This association was not present in the unadjusted analysis. The relationship between SRS and the primary outcome was likely due to a higher event ratein patients with ischemic HF and a low SRS. The LV phase SD was not predictive of the primary outcome (hazard ratio 1.00, 95% confidence interval 0.99-1.01, P = .49). In a post hoc analysis, nuclear variables provided incremental prognostic information when added to clinical information (P = .006).

Conclusions

Gated SPECT MPI provides important information in patients with HF and reduced LVEF. In the adjusted analysis, SRS has an unexpected relationship with the primary end point. Phase SD was not associated with the primary end point. Rest-gated SPECT MPI provides incrementally greater prognostic information than clinical information alone.

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Incremental prognostic value

Clinical implications

Limitations

Conclusion

Disclosures

	Hector O. Ventura, MD, served as guest editor for this article.
	Clinicaltrials.gov identifier: NCT00047437.
	Funding sources: This study was funded by the National Institutes of Health, National Heart Lung and Blood Institute, and GE Healthcare. This research was supported by National Institutes of Health grants: 5U01HL063747, 5U01HL068973, 5U01HL066501, 5U01HL066482, 5U01HL064250, 5U01HL066494, 5U01HL064257, 5U01HL066497, 5U01HL068980, 5U01HL064265, 5U01HL066491, 5U01HL064264, 5U01HL066461, R37AG18915, P60AG10484.

Esportazione

Vol 161 - N° 6

P. 1038-1045 - Giugno 2011 Ritorno al numero

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Relationship of technetium-99m tetrofosmin-gated rest single-photon emission computed tomography myocardial perfusion imaging to death and hospitalization in heart failure patients: results from the nuclear ancillary study of the HF-ACTION trial - 06/08/11

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Results

Conclusions

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