Skip to main content
SpringerLink
Log in

Prediction of sudden cardiac death in chronic heart failure patients with reduced ejection fraction by ADMIRE-HF risk score and early repolarization pattern

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

AdreView myocardial imaging for risk evaluation in heart failure (ADMIRE-HF) risk score is a novel risk score to predict serious arrhythmic risk in chronic heart failure patients with reduced ejection fraction (HFrEF). Moreover, early repolarization pattern (ERP) has been shown to be associated with an increased risk of sudden cardiac death (SCD) in HFrEF patients. We sought to investigate the prognostic value of combining ADMIRE-HF risk score and ERP to predict SCD in HFrEF patients.

Methods

We studied 90 HFrEF outpatients with LVEF< 40% in our prospective cohort study. In cardiac MIBG imaging, the heart-to-mediastinum (H/M) ratio was measured on the delayed planar image. ADMIRE-HF risk score was derived from the sum of the point values of LVEF, H/M ratio, and systolic blood pressure. We also assessed ERP on the standard electrocardiogram.

Results

During a median follow-up of 7.5(4.5-12.0) years, 22 patients had SCD. At multivariate Cox analysis, ADMIRE-HF risk score and ERP were independently associated with SCD. Patients with both intermediate/high ADMIRE-HF score and ERP had a higher SCD risk than those with either and none of them.

Conclusion

The combination of ADMIRE-HF risk score and ERP would provide the incremental prognostic information for predicting SCD in HFrEF patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

Abbreviations

ADMIRE-HF:

AdreView myocardial imaging for risk evaluation in heart failure

HFrEF:

Heart failure reduced ejection fraction

ERP:

Early repolarization pattern

SCD:

Sudden cardiac death

MIBG:

Metaiodobenzylguanidine

LVEF:

Left ventricular ejection fraction

H/M:

Heart to mediastinum

ICD:

Implantable cardioverter defibrillator

References

  1. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Multicenter automatic defibrillator implantation trial II investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877-883.

  2. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Sudden cardiac death in heart failure trial (SCD-HeFT) investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225-237.

  3. Merlet P, Valette H, Dubois-Randé JL, Moyse D, Duboc D, Dove P, et al. Prognostic value of cardiac metaiodobenzylguanidine imaging in patients with heart failure. J Nucl Med 1992;33:471-7.

    CAS  PubMed  Google Scholar 

  4. Ogita H, Shimonagata T, Fukunami M, Kumagai K, Yamada T, Asano Y, et al. Prognostic significance of cardiac I-123 metaiodobenzylguanidine imaging for mortality and morbidity in patients with chronic heart failure: A prospective study. Heart 2001;86:656-60.

    Article  CAS  Google Scholar 

  5. Yamada T, Shimonagata T, Fukunami M, Kumagai K, Ogita H, Hirata A, et al. Comparison of the prognostic value of cardiac iodine-123 metaiodobenzylguanidine imaging and heart rate variability in patients with chronic heart failure: a prospective study. J Am Coll Cardiol 2003;41:231-8.

    Article  Google Scholar 

  6. Kioka H, Yamada T, Mine T, Morita T, Tsukamoto Y, Tamaki S, et al. Prediction of sudden death in patients with mild-to-moderate chronic heart failure by using cardiac iodine-123 metaiodobenzylguanidine imaging. Heart 2007;93:1213-8.

    Article  Google Scholar 

  7. Tamaki S, Yamada T, Okumura Y, Morita T, Sanada S, Tsukamoto Y, et al. Cardiac iodine-123 metaiodobenzylguanidine imaging predicts sudden cardiac death independently of left ventricular ejection fraction in patients with chronic heart failure and left ventricular systolic dysfunction. J Am Coll Cardiol 2009;53:426-35.

    Article  CAS  Google Scholar 

  8. Jacobson AF, Senior R, Cerqueira, Wong ND, Thomas GS, Lopez VA, et al. ADMIRE-HF Investigators. Myocardial 123I-mIBG imaging and cardiac events in heart failure: results of the prospective ADMIRE-HF study. J Am Coll Cardiol 2010;55:2212-2221.

  9. Kuramoto Y, Yamada T, Tamaki S, Okuyama Y, Morita T, Furukawa Y, et al. Usefulness of cardiac iodine-123 meta-iodobenzylguanidine imaging to improve prognostic power of Seattle heart failure model in patients with chronic heart failure. Am J Cardiol 2011;107:1185-90.

    Article  Google Scholar 

  10. Nakata T, Nakajima K, Yamashina S, Yamada T, Momose M, Kasama S, et al. A pooled analysis of multicenter cohort studies of (123)I-mIBG imaging of sympathetic innervation for assessment of long-term prognosis in heart failure. JACC Cardiovasc Imaging 2013;6:772-84.

    Article  Google Scholar 

  11. Kawai T, Yamada T, Tamaki S, Morita T, Furukawa Y, Iwasaki Y, et al. Usefulness of cardiac meta-iodobenzylguanidine imaging to identify patients with chronic heart failure and left ventricular ejection fraction <35% at low risk of sudden cardiac death. Am J Cardiol 2015;115:1549-54.

    Article  CAS  Google Scholar 

  12. Hakui H, Yamada T, Tamaki S, Morita T, Furukawa Y, Iwasaki Y, et al. Usefulness of cardiac metaiodobenzylguanidine imaging to improve prognostic power of the model for end-stage liver disease scoring system in patients with mild-to-moderate chronic heart failure. Am J Cardiol 2016;117:1947-52.

    Article  Google Scholar 

  13. Nakajima K, Scholte A, Nakata T, Dimitriu-Leen AC, Chikamori T, Vitola J, et al. Cardiac sympathetic nervous system imaging with 123I-meta-iodobenzylguanidine: Perspectives from Japan and Europe. J Nucl Cardiol 2017;24:952-60.

    Article  Google Scholar 

  14. Al Badarin FJ, Wimmer AP, Kennedy KF, Jacobson AF, Bateman TM. The utility of ADMIRE-HF risk score in predicting serious arrhythmic events in heart failure patients: incremental prognostic benefit of cardiac 123I-mIBG scintigraphy. J Nucl Cardiol 2014;21:756-62.

    Article  Google Scholar 

  15. Gussak I, Antzelevitch C. Early repolarization syndrome: clinical characteristics and possible cellular and ionic mechanisms. J Electrocardiol 2000;33:299-309.

    Article  CAS  Google Scholar 

  16. Haïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med 2008;358:2016-2023.

  17. Rosso R, Kogan E, Belhassen B, Rozovski U, Scheinman MM, Zeltser D, et al. J-point elevation in survivors of primary ventricular fibrillation and matched control subjects: incidence and clinical significance. J Am Coll Cardiol 2008;52:1231-8.

    Article  Google Scholar 

  18. Tikkanen JT, Anttonen O, Junttila MJ, Aro AL, Kerola T, Rissanen HA, et al. Long-term outcome associated with early repolarization on electrocardiography. N Engl J Med 2009;361:2529-37.

    Article  CAS  Google Scholar 

  19. Patel RB, Ng J, Reddy V, Chokshi M, Parikh K, Subacius H, Alsheikh-Ali AA, et al. Early repolarization associated with ventricular arrhythmias in patients with chronic coronary artery disease. Circ Arrhythm Electrophysiol 2010;3:489-95.

    Article  Google Scholar 

  20. Pei J, Li N, Gao Y, Wang Z, Li X, Zhang Y, et al. The J wave and fragmented QRS complexes in inferior leads associated with sudden cardiac death in patients with chronic heart failure. Europace 2012;14:1180-7.

    Article  Google Scholar 

  21. Furukawa Y, Yamada T, Morita T, Iwasaki Y, Kawasaki M, Kikuchi A, et al. Early repolarization pattern associated with sudden cardiac death: long-term follow-up in patients with chronic heart failure. J Cardiovasc Electrophysiol 2013;24:632-9.

    Article  Google Scholar 

  22. McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: The Framingham study. N Engl J Med 1971;285:1441-6.

    Article  CAS  Google Scholar 

  23. Floras JS. Clinical aspects of sympathetic activation and parasympathetic withdrawal in heart failure. J Am Coll Cardiol 1993;22:72A-84A.

    Article  CAS  Google Scholar 

  24. Schwartz PJ, La Rovere MT, Vanoli E. Autonomic nervous system and sudden cardiac death. Experimental basis and clinical observations for post-myocardial infarction risk stratification. Circulation 1992;85(1 Suppl):I77-91

  25. Borgquit R, Singh JP. An electrophysiological perspective on risk stratification in heart failure: can better understanding of the condition of the cardiac sympathetic nervous system help? J Nucl Med 2015;56:59S-64S.

    Article  Google Scholar 

  26. Lee HY, Mun HS, Wi J, Uhm JS, Shim J, Kim JY, et al. Early repolarization and myocardial scar predict poorest prognosis in patients with coronary artery disease. Yonsei Med J 2014;55:928-36.

    Article  Google Scholar 

  27. Klatsky AL, Oehm R, Cooper RA, Udaltsova N, Armstrong MA. The early repolarization normal variant electrocardiogram: correlates and consequences. Am J Med 2003;115:171-7.

    Article  Google Scholar 

  28. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002 21;346:877-883.

  29. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Sudden cardiac death in heart failure trial (SCD-HeFT) investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005 20;352:225-237.

  30. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, et al. American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; Heart Rhythm Society. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2013;127:e283-e352.

  31. Moss AJ, Greenberg H, Case RB, Zareba W, Hall WJ, Brown MW, et al. Multicenter automatic defibrillator implantation trial-II (MADIT-II) research group. Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation 2004;110:3760-3765.

  32. Zecchin M, Merlo M, Pivetta A, Barbati G, Lutman C, Gregori D, et al. How can optimization of medical treatment avoid unnecessary implantable cardioverter-defibrillator implantations in patients with idiopathic dilated cardiomyopathy presenting with “SCD-HeFT criteria?”. Am J Cardiol 2012;109:729-35.

    Article  Google Scholar 

Download references

Disclosure

Iyo Ikeda-Yorifuji, Takahisa Yamada, Shunsuke Tamaki, Takashi Morita, Yoshio Furukawa, Yusuke Iwasaki, Masato Kawasaki, Atsushi Kikuchi, Tsutomu Kawai, Masahiro Seo, Eiji Fukuhara, Makoto Abe, Jun Nakamura and Masatake Fukunami have no finantial or other relationships that could lead to a conflict of interest associated with this study.

Author information

Authors and Affiliations

  1. Division of Cardiology, Osaka General Medical Center, 3-1-56, Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan

    Iyo Ikeda-Yorifuji MD, Takahisa Yamada MD, PhD, Shunsuke Tamaki MD, PhD, Takashi Morita MD, PhD, Yoshio Furukawa MD, PhD, Yusuke Iwasaki MD, Masato Kawasaki MD, Atsushi Kikuchi MD, Tsutomu Kawai MD, Masahiro Seo MD, Eiji Fukuhara MD, Makoto Abe MD, Jun Nakamura MD & Masatake Fukunami MD, PhD

Authors
  1. Iyo Ikeda-Yorifuji MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takahisa Yamada MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shunsuke Tamaki MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Morita MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshio Furukawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yusuke Iwasaki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masato Kawasaki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Atsushi Kikuchi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tsutomu Kawai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Masahiro Seo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Eiji Fukuhara MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Makoto Abe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jun Nakamura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Masatake Fukunami MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takahisa Yamada MD, PhD.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 1351 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ikeda-Yorifuji, I., Yamada, T., Tamaki, S. et al. Prediction of sudden cardiac death in chronic heart failure patients with reduced ejection fraction by ADMIRE-HF risk score and early repolarization pattern. J. Nucl. Cardiol. 27, 992–1001 (2020). https://doi.org/10.1007/s12350-019-01639-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-019-01639-6

Keywords

Search

Navigation