A1 Refereed original research article in a scientific journal
The Alternative Imaging Modalities in Ischemic Heart Failure (AIMI-HF) Trial—IMAGE HF Project 1A
Authors: Mielniczuk, Lisa M.; O’Meara, Eileen; Wiefels, Christiane; Chen, Li; Garrard, Linda; White, James; deKemp, Robert A.; Di Carli, Marcelo F.; Larose, Eric; Paterson, David I.; Ezekowitz, Justin; Kandolin, Riina M.; Wright, Graham; Campisi, Roxana; Laine, Mika K.; Connelly, Kim; Rajda, Miroslaw; Vitola, Joao V.; Lepage, Serge; Hartikainen, Juha; Chow, Benjamin; Tavoosi, Anahita; Knuuti, Juhani; Wells, George A.; Beanlands, Rob S.B.; and the IMAGE HF Investigators
Publisher: Elsevier BV
Publication year: 2025
Journal:: CJC Open
eISSN: 2589-790X
DOI: https://doi.org/10.1016/j.cjco.2025.06.023
Web address : https://doi.org/10.1016/j.cjco.2025.06.023
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/504912237
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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Funding information in the publication:
This study was supported by a joint team grant from the Canadian Institutes of Health Research (grant #CIF99470) and Business Finland. Funding was supplemented by the Heart and Stroke Foundation of Ontario, Canada (grant #G-17-0018349) and a small (< $10,000) unrestricted grant from General Electric Healthcare.
L.M.M. is supported by a University of Ottawa Tier 1 Chair in Heart Function and reports receiving honoraria and consultant fees from Astra Zeneca, Bayer, Novartis, Servier, Janssen, Boehringher-Ingelheim, and Merck. E.O. is supported by The Carolyn and Richard J. Renaud Research Chair in Heart Failure at the Montreal Heart Institute; and reports receiving honoraria and consultant fees from Astra Zeneca, Bayer, Boehringher-Ingelheim, Novartis, and Novo Nordisk. R.S.B.B. is supported in part by the University of Ottawa Distinguished Chair in Cardiovascular Imaging Research and reports receiving honoraria from and/or leads grants supported by GE Healthcare, Jubilant DraxImage, Lantheus Medical Imaging, and MedTrace. J.K. reports receiving consultancy fees from GE Healthcare and AstraZeneca, and speaker fees from GE Healthcare, Bayer, Lundbeck, Boehringer-Ingelheim, Pfizer, Siemens, and Merck, outside of the submitted work. J.W. is a shareholder in Cohesic Inc and reports receiving research support from Siemens Healthineers, Circle Cardiovascular Inc., and Pfizer. R.A.D. reports receiving royalties from rubidium-82 PET technologies licensed to Jubilant Radiopharma and to INVIA Medical Solutions; and receiving research funding and honoraria from Jubilant Radiopharma and IONETIX. M.F.D.C. reports receiving institutional grant support from Gilead Sciences; institutional in-kind support from Amgen; and consulting honoraria from MedTrace and Sanofi. K.C. reports being an inventor on a patent application by Boehringer Ingelheim; and receiving research support, grants, and/or honoraria from AstraZeneca, Servier, Boehringer Ingelhei, Eli Lilly, Janssen, Merck, Novartis, and Novo Nordisk. B.C. reports receiving research support from TD Bank, AusculSciences, Siemens Healthineers, and Artrya; and being a consultant to and having equity interest in Artrya.
