The Alternative Imaging Modalities in Ischemic Heart Failure (AIMI-HF) Trial—IMAGE HF Project 1A

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-11-01 Epub Date: 2025-07-16 DOI:10.1016/j.cjco.2025.06.023

Lisa M. Mielniczuk MD , Eileen O’Meara MD , Christiane Wiefels MD , Li Chen MSc , Linda Garrard RN , James White MD , Robert A. deKemp PhD , Marcelo F. Di Carli MD , Eric Larose MD , David I. Paterson MD , Justin Ezekowitz MB , Riina M. Kandolin MD , Graham Wright PhD , Roxana Campisi MD , Mika K. Laine MD , Kim Connelly MBBS, PhD , Miroslaw Rajda MD , Joao V. Vitola MD , Serge Lepage MD , Juha Hartikainen MD , Rob S.B. Beanlands MD

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Abstract

Background

The role of advanced (cardiac magnetic resonance [CMR] or positron emission tomography [PET]) vs single-photon emission computerized tomography (SPECT) ischemia imaging to guide management remains unclear in patients with ischemic heart failure (IHF). The primary aim was to determine the effect of imaging modality on a composite cardiovascular endpoint and cardiac death in patients with IHF who require ischemia assessment.

Methods

Patients with IHF were randomized to advanced or SPECT imaging. A parallel registry also was performed. The primary endpoint was the composite of cardiac death, infarction, arrest, and cardiac rehospitalization. The key secondary endpoint was cardiac death.

Results

Patients in the randomized population (advanced imaging [PET or CMR; n = 64] or SPECT [n = 56]) had a cumulative incidence rate (CIR) for the primary endpoint of 33.1% and 33.0%, respectively (hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.49, 1.80, P = 0.853). CIRs for cardiac death were 13.8% and 25.1%, respectively (HR 0.62, 95% CI 0.25, 1.80, P = 0.296).

In the parallel registry (n = 336 advanced; n = 216 SPECT), the primary endpoint CIRs were 31.2% and 35.3%, respectively (HR 0.81, 95% CI 0.56, 1.19, P = 0.284). CIRs for cardiac death were 11.0% and 16.6%, respectively (HR 0.53, 95% CI 0.27, 1.04, P = 0.066). Patients were followed for a median (interquartile range) of 24.1 (11.6, 27.5) months.

Pooled analysis from the randomized and registry populations revealed a significant benefit of advanced imaging for reduction of cardiac death (HR 0.56, 95% CI 0.33, 0.96, P = 0.04) with minimal heterogeneity (I² = 0%).

Conclusion

Among IHF patients assessed for ischemia, advanced imaging (PET or CMR) was not associated with reduced composite cardiac events, compared to SPECT.

Clinical Trial Registration

NCT01288560.

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缺血性心力衰竭（AIMI-HF）试验的替代成像方式- image HF项目1A

在缺血性心力衰竭（IHF）患者中，高级心脏磁共振（CMR）或正电子发射断层扫描（PET）与单光子发射计算机断层扫描（SPECT）缺血成像在指导治疗中的作用尚不清楚。主要目的是确定成像方式对需要缺血评估的IHF患者复合心血管终点和心源性死亡的影响。方法将IHF患者随机分为高级或SPECT组。还执行了一个并行注册表。主要终点为心源性死亡、梗死、骤停和心脏再住院。主要的次要终点是心源性死亡。结果随机分组患者（高级影像学[PET或CMR； n = 64]或SPECT [n = 56]）主要终点的累积发病率（CIR）分别为33.1%和33.0%（风险比[HR] 0.94, 95%可信区间[CI] 0.49, 1.80, P = 0.853）。心源性死亡的CIRs分别为13.8%和25.1% （HR 0.62, 95% CI 0.25, 1.80, P = 0.296）。在平行注册中（n = 336例晚期，n = 216例SPECT），主要终点CIRs分别为31.2%和35.3% （HR 0.81, 95% CI 0.56, 1.19, P = 0.284）。心源性死亡的CIRs分别为11.0%和16.6% （HR 0.53, 95% CI 0.27, 1.04, P = 0.066）。患者随访的中位数（四分位数范围）为24.1（11.6,27.5）个月。来自随机和登记人群的汇总分析显示，先进成像对降低心脏性死亡有显著益处（HR 0.56, 95% CI 0.33, 0.96, P = 0.04），异质性最小（I2 = 0%）。结论在评估为缺血的IHF患者中，与SPECT相比，晚期成像（PET或CMR）与减少复合心脏事件无关。临床试验注册编号：nct01288560。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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