Etiology and pathophysiology of new-onset heart failure: evaluation by myocardial perfusion imaging

J Nucl Cardiol. 2009 Jan-Feb;16(1):82-91. doi: 10.1007/s12350-008-9010-8. Epub 2009 Jan 20.

Abstract

Objective: The IMAGING in Heart Failure study was a prospective, multi-national trial designed to explore the role of single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (MPI) as an initial investigative strategy in patients hospitalized with new-onset heart failure.

Methods: We recruited 201 patients (age 65.3 +/- 14.5 years, 43% women) hospitalized with their first episode of heart failure. Rest/stress gated SPECT Tc-99m sestamibi MPI was performed during or within 2 weeks of the index hospitalization, in addition to standard care.

Results: SPECT MPI revealed a broad range of ejection fractions with preserved systolic function in 36% of patients. Forty-one percent of patients had normal perfusion. In the remaining patients, perfusion abnormalities were predominantly due to prior myocardial infarction, with extensive ischemia seen only in 6%. Among patients who underwent coronary angiography, SPECT performance characteristics revealed excellent negative predictive value (96%) for extensive coronary artery disease (CAD). In multivariable analyses, the extent of perfusion abnormality and advancing age predicted the presence of extensive CAD.

Conclusions: These preliminary data derived from a non-randomized observational cohort suggest potential diagnostic utility of MPI for ischemic LV dysfunction in new-onset HF, and sets the stage for a prospective randomized study to confirm these findings.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Comorbidity
  • Female
  • Heart Failure / diagnostic imaging*
  • Heart Failure / epidemiology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Radiopharmaceuticals
  • Risk Assessment / methods
  • Risk Factors
  • Technetium Tc 99m Sestamibi*
  • Tomography, Emission-Computed, Single-Photon / statistics & numerical data*
  • United Kingdom / epidemiology
  • United States / epidemiology
  • Ventricular Dysfunction, Left / diagnostic imaging*
  • Ventricular Dysfunction, Left / epidemiology*

Substances

  • Radiopharmaceuticals
  • Technetium Tc 99m Sestamibi