Home > Cardiology > ACC 2023 > Heart Failure and Cardiomyopathy > No difference in CV outcomes between PET or CMR and SPECT

No difference in CV outcomes between PET or CMR and SPECT

Presented by
Prof. Lisa Mielniczuk, University of Ottawa, Canada
Conference
ACC 2023
Trial
AIMY-HF
Doi
https://doi.org/10.55788/c3fee35c
The AIMI-HF trial found no significant advantage of advanced imaging modalities with PET or CMR compared with SPECT on a cardiovascular (CV) composite in patients with heart failure (HF) due to ischaemic heart disease. However, in a subgroup of patients evaluated for ischaemia, an advanced imaging strategy may be associated with a reduction in CV death.

Prof. Lisa Mielniczuk (University of Ottawa, Canada), who presented the results, said that the role of revascularisation in patients with HF due to underlying ischaemic heart disease remains subject to debate [1]. The overall objective of the pragmatic AIMY-HF (NCT01288560) was to determine the impact of advanced imaging modalities with PET or CMR compared with SPECT on a CV composite of cardiac death, myocardial infarction (MI), resuscitated cardiac arrest, and cardiac hospitalisation.

Enrolled participants had HF with reduced ejection fraction (HFrEF) and suspected or known coronary artery disease. Participants were first evaluated for either the burden of their ischaemia or existing evidence of myocardial viability. Then 271 participants from 15 sites were randomised to advanced (CMR or PET) or standard (SPECT) imaging modalities, depending on availability at their site. An additional registry arm was created (n=1,110) to enhance the study's power and to allow patients to be included who could not be randomised, either due to contraindication or clinician preference. The primary outcome was time to CV composite. Of the 1,381 participants, 672 had ischaemia as the primary clinical question and 709 myocardial viability. The advanced imaging group had 1,069 patients, and the SPECT group included 312. The median follow-up was 24.1 months.

In the total study population, the cumulative incidence of the primary composite outcome occurred in 31% and 35% of patients undergoing CMR or PET and SPECT, respectively. The difference was not statistically significant (HR 0.95; 95% CI 0.71–1.25; P=0.696). In the ischaemia cohort, the difference did not reach statistical significance either (HR 0.86; 95% CI 0.61–1.21; P=0.388). Prof. Mielniczuk added that there was a marginally significant reduction in cardiac death in the PET arm of the ischaemia cohort versus the SPECT arm (HR 0.61; 95% CI 0.38–1.00; P=0.05).

Turning to the randomised patients, no difference was observed in the primary composite outcome either, occurring in 28% in the CMT or PET group versus 30% in the SPECT group (HR 0.88; 95% CI 0.55–1.43; P=0.662). There was also no significant difference in cardiac death.

In the total population, patients in the advanced imaging group were more likely to undergo revascularisation (P<0.0001), with 61% undergoing revascularisation via CABG. Although not reaching statistical significance, a trend was observed toward benefit for patients who underwent revascularisation after CMT or PET imaging.

Prof. Mielniczuk concluded that the imaging strategy was not associated with a difference in CV outcomes in patients with HF. Whether an advanced imaging modality is associated with a reduction in CV death compared with SPECT would need to be evaluated in future studies.

  1. Mielniczuk L. Ischemia and viability imaging in heart failure: The alternative imaging modalities in ischemic heart failure trial. Session 403-12, ACC Scientific Session 2023, 4–6 March, New Orleans, USA.

 

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