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

Area of Science:

• Cardiology
• Medical Imaging
• Heart Failure Research

Background:

• Ischemic heart failure (IHF) management requires accurate ischemia assessment.
• The comparative effectiveness of advanced cardiac imaging (cardiac magnetic resonance [CMR] or positron emission tomography [PET]) versus single-photon emission computerized tomography (SPECT) in guiding IHF management is not well-established.

Purpose of the Study:

• To evaluate the impact of advanced imaging modalities (PET or CMR) versus SPECT on cardiovascular outcomes in patients with IHF.
• To determine if advanced imaging reduces a composite endpoint and cardiac death in IHF patients requiring ischemia assessment.

Main Methods:

• Patients with IHF were randomized to either advanced imaging (PET or CMR) or SPECT.
• A parallel registry study was also conducted.
• The primary endpoint was a composite of cardiac death, infarction, arrest, and cardiac rehospitalization; cardiac death was a key secondary endpoint.

Main Results:

• In the randomized population, the primary endpoint cumulative incidence rate (CIR) was similar between advanced imaging (33.1%) and SPECT (33.0%).
• In the registry, CIRs for the primary endpoint were 31.2% for advanced imaging and 35.3% for SPECT.
• Pooled analysis revealed a significant reduction in cardiac death with advanced imaging (HR 0.56, 95% CI 0.33, 0.96, P = 0.04).

Conclusions:

• Advanced imaging (PET or CMR) did not significantly reduce the composite cardiovascular endpoint compared to SPECT in IHF patients.
• However, pooled data suggest a potential benefit of advanced imaging in reducing cardiac death among IHF patients.