Heart Failure (HF), Ventricular Dysfunction, Left
Conditions
Keywords
Nuclear imaging, Radiopharmaceutical, Iobenguane, I-123, reproducibility, Quantitative measurements, myocardial uptake, SPECT imaging, planar imaging, AdreView™
Brief summary
The aim of the study was to assess the reproducibility of quantitative measurements of myocardial uptake of Iobenguane I 123 on planar and single photon emission computed tomography (SPECT) imaging following intravenous (i.v.) administration of AdreView. Efficacy was assessed based upon the absolute differences between quantitative analyses of imaging data on 2 scans performed 5 to 14 days apart.
Interventions
DRUGAdreView (Iobenguane I 123 Injection)
AdreView 10 mCi as a single i.v administration
Sponsors
H2O Clinical LLC
Quintiles, Inc.
GE Healthcare
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* The participant was originally diagnosed with New York Heart Association (NYHA) Class II-III HF due to ischemic heart disease at least 3 months or due to non-ischemic cardiomyopathy at least 6 months before enrollment into the study. * The participant had Left Ventricular (LV) dysfunction with Left Ventricular Ejection Fraction (LVEF) less than or equal to 35% measured by an appropriate method (e.g., radionuclide or contrast ventriculography, electrocardiogram \[ECG\]-gated SPECT myocardial perfusion imaging \[MPI\], magnetic resonance \[MR\] imaging, computed tomography \[CT\] or echocardiography) within 6 months of enrollment into the study and documented in the participant's medical record. * The participant had a history of compliance with prescribed heart failure (HF) medications and took HF guidelines-based medication at study entry including at a minimum a beta-blocker and either an angiotensin converting enzyme inhibitor or angiotensin receptor antagonist unless documented to be intolerant to any of these classes of medications. * The participant had been on a stable medical regimen for a minimum of 3 months, with no hospitalizations or change in HF medications or HF symptoms. * Participants must be clinically stable for at least 7 days before enrolling into the study (e.g., not experiencing continuing chest pain or hemodynamic instability).
Exclusion criteria
* The participant had previously received 123 I-mIBG or 131 I-mIBG. * The participant had known or suspected hypersensitivity/allergy to iodine, Iobenguane or to any of the excipients in AdreView. * The participant had a heart transplant at any time prior to enrollment. * The participant had LVEF \>35% as measured by an appropriate method (e.g., radionuclide or contrast ventriculography, ECG-gated SPECT MPI, MR, CT, or echocardiography) within 30 days prior to enrollment into the study. * The participant had received defibrillation either external or via an implantable cardioverter defibrillator (ICD), anti-tachycardia pacing, or cardioversion to treat an arrhythmic event in the previous 90 days. * The participant had a cardiac revascularization, insertion of an ICD, or acute myocardial infarction within 30 days before study entry. * The participant used any of the following medications: Amitriptyline and derivatives, imipramine and derivatives, other antidepressants that inhibit the norepinephrine transporter, antihypertensives that deplete norepinephrine stores or inhibit reuptake, sympathomimetic amines and cocaine. * The participant had either NYHA Class I or NYHA Class IV HF at the time of study entry. * The participant had renal insufficiency (creatinine \>3 mg/dl). * The participant had participated in a clinical trial involving IMP or devices within 30 days prior to first administration of AdreView™. * In the investigator's opinion, the participant's medical history included either extensive lifetime exposure to ionizing radiation (medical, occupational, other) or documented total radiation dose \>50 mSv during the previous 5 years. * The participant had experienced HF hospitalization, increased HF symptoms without hospitalization, or had a change or increase in HF medications during the previous 3 months. * The participant had a serious non-cardiac medical condition associated with significant elevation of plasma catecholamines, including pheochromocytoma.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | 3 Hours 50 Minutes post administration of 2 dosing within an interval of 5 to 14 days | Participants underwent 2 AdreView (Iobenguane I 123 Injection) exams on the same gamma camera within 5 to 14 days, with the requirement that there was no change in the clinical condition of the participant or in the imaging equipment between the 2 procedures. Each imaging study was processed and read independently by 3 technologists. Mean heart/mediastinum (H/M) ratio difference (with 95% confidence interval \[CI\]) was used as the measure of test stability. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | 15 minutes post administration of 2 dosing within an interval of 5 to 14 days | Measurements of H/M ratio and the extent of difference between H/M measurements following AdreView administration and 15 minutes delayed planar imaging on 2 separate days within an interval of 5 to 14 days, was used to assess the test-retest reproducibility. Data from test-retest study was used to estimate the normal ranges for variation in quantitation of myocardial tracer uptake using AdreView. H/M ratios were calculated by 3 technologists and average of 3 technologists was calculated based on non-missing technologists reviewing results. All non-missing technologist evaluations were averaged per participant. |
Countries
United States
Participant flow
Recruitment details
The study was conducted at 10 centers in US. A total of 63 participants were enrolled in the study between 16 August 2013 and 20 February 2014.
Pre-assignment details
Out of 63 enrolled participants, 51 received at least 1 administration of AdreView (Iobenguane I 123 injection) and 50 participants received 2 administrations of AdreView. Myocardial AdreView uptake over time was quantitatively measured via planar and single photon emission computed tomography (SPECT) imaging at various time points post-injection.
Participants by arm
| Arm | Count |
|---|---|
| AdreView (Iobenguane I 123 Injection) Two administrations of single i.v. injection of Iobenguane I 123 10 mCi (370 MBq) over 1 to 2 minutes within an interval of 5 to 14 days. | 51 |
| Total | 51 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Other than specified above | 5 |
| Overall Study | Physician Decision | 2 |
| Overall Study | Protocol Violation | 2 |
| Overall Study | Withdrawal by Subject | 4 |
Baseline characteristics
| Characteristic | AdreView (Iobenguane I 123 Injection) |
|---|---|
| Age, Continuous | 65.2 years STANDARD_DEVIATION 12.46 |
| Region of Enrollment United States | 51 participants |
| Safety Assessment | 51 participants |
| Sex: Female, Male Female | 8 Participants |
| Sex: Female, Male Male | 43 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 51 |
| serious Total, serious adverse events | 0 / 51 |
Outcome results
Primary
To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection)
Participants underwent 2 AdreView (Iobenguane I 123 Injection) exams on the same gamma camera within 5 to 14 days, with the requirement that there was no change in the clinical condition of the participant or in the imaging equipment between the 2 procedures. Each imaging study was processed and read independently by 3 technologists. Mean heart/mediastinum (H/M) ratio difference (with 95% confidence interval \[CI\]) was used as the measure of test stability.
Time frame: 3 Hours 50 Minutes post administration of 2 dosing within an interval of 5 to 14 days
Population: Efficacy population that included all participants who underwent 2 administrations of AdreView (Iobenguane I 123 Injection); had at least an interpretable planar image acquisition at 3 hours 50 minutes post-injection after each AdreView administration. Here, 'n' signifies number of participants analyzed by the technologist.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| AdreView (Iobenguane I 123 Injection) | To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | Technologist B (post dosing-2) (n=47) | 1.436 Ratio | Standard Deviation 0.2069 |
| AdreView (Iobenguane I 123 Injection) | To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | Average (post dosing-1) (n=47) | 1.429 Ratio | Standard Deviation 0.216 |
| AdreView (Iobenguane I 123 Injection) | To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | Average (post dosing-2) (n=47) | 1.433 Ratio | Standard Deviation 0.2048 |
| AdreView (Iobenguane I 123 Injection) | To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | Technologist A (post dosing-1) (n=46) | 1.435 Ratio | Standard Deviation 0.2238 |
| AdreView (Iobenguane I 123 Injection) | To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | Technologist A (post dosing-2) (n=47) | 1.422 Ratio | Standard Deviation 0.2229 |
| AdreView (Iobenguane I 123 Injection) | To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | Technologist A(Dosings:absolute difference) (n=46) | 0.070 Ratio | Standard Deviation 0.0612 |
| AdreView (Iobenguane I 123 Injection) | To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | Technologist B (post dosing-1) (n=47) | 1.430 Ratio | Standard Deviation 0.22 |
| AdreView (Iobenguane I 123 Injection) | To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | Technologist B(Dosings:absolute difference) (n=47) | 0.060 Ratio | Standard Deviation 0.0413 |
| AdreView (Iobenguane I 123 Injection) | To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | Technologist C (post dosing-1) (n=47) | 1.427 Ratio | Standard Deviation 0.2115 |
| AdreView (Iobenguane I 123 Injection) | To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | Technologist C (post dosing-2) (n=47) | 1.441 Ratio | Standard Deviation 0.1945 |
| AdreView (Iobenguane I 123 Injection) | To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | Technologist C(Dosings:absolute difference) (n=47) | 0.067 Ratio | Standard Deviation 0.0537 |
| AdreView (Iobenguane I 123 Injection) | To Assess Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake in Heart Failure (HF) Participants on Planar Imaging at 3 Hours 50 Minutes Following I.V. Injection of AdreView (Iobenguane I 123 Injection) | Average (Dosings:absolute difference) (n=47) | 0.065 Ratio | Standard Deviation 0.0348 |
Secondary
To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection)
Measurements of H/M ratio and the extent of difference between H/M measurements following AdreView administration and 15 minutes delayed planar imaging on 2 separate days within an interval of 5 to 14 days, was used to assess the test-retest reproducibility. Data from test-retest study was used to estimate the normal ranges for variation in quantitation of myocardial tracer uptake using AdreView. H/M ratios were calculated by 3 technologists and average of 3 technologists was calculated based on non-missing technologists reviewing results. All non-missing technologist evaluations were averaged per participant.
Time frame: 15 minutes post administration of 2 dosing within an interval of 5 to 14 days
Population: Efficacy population that included all participants who underwent 2 administrations of AdreView; had at least an interpretable planar image acquisition at 15 minutes post-injection after each AdreView administration. Here, 'n' signifies number of participants analyzed by the technologist.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| AdreView (Iobenguane I 123 Injection) | To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | Technologist A (post dosing-2) (n=47) | 1.567 Ratio | Standard Deviation 0.2267 |
| AdreView (Iobenguane I 123 Injection) | To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | Technologist A(Dosings:absolute difference) (n=47) | 0.081 Ratio | Standard Deviation 0.0765 |
| AdreView (Iobenguane I 123 Injection) | To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | Technologist B (post dosing-2) (n=47) | 1.553 Ratio | Standard Deviation 0.2169 |
| AdreView (Iobenguane I 123 Injection) | To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | Technologist B(Dosings:absolute difference) (n=47) | 0.062 Ratio | Standard Deviation 0.0532 |
| AdreView (Iobenguane I 123 Injection) | To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | Technologist C (post dosing-2) (n=47) | 1.571 Ratio | Standard Deviation 0.2203 |
| AdreView (Iobenguane I 123 Injection) | To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | Technologist A (post dosing-1) (n=47) | 1.584 Ratio | Standard Deviation 0.2258 |
| AdreView (Iobenguane I 123 Injection) | To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | Technologist B (post dosing-1) (n=47) | 1.568 Ratio | Standard Deviation 0.2262 |
| AdreView (Iobenguane I 123 Injection) | To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | Technologist C(Dosing:absolute difference) (n=47) | 0.071 Ratio | Standard Deviation 0.0541 |
| AdreView (Iobenguane I 123 Injection) | To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | Average (post dosing-1) (n=47) | 1.581 Ratio | Standard Deviation 0.2212 |
| AdreView (Iobenguane I 123 Injection) | To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | Average (post dosing-2) (n=47) | 1.564 Ratio | Standard Deviation 0.2195 |
| AdreView (Iobenguane I 123 Injection) | To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | Average (Dosings:absolute difference) (n=47) | 0.072 Ratio | Standard Deviation 0.0485 |
| AdreView (Iobenguane I 123 Injection) | To Assess the Test-retest Reproducibility of Iobenguane I 123 Injection Myocardial Uptake on Planar Imaging at 15 Minutes Following Administration of AdreView (Iobenguane I 123 Injection) | Technologist C (post dosing-1) (n=47) | 1.593 Ratio | Standard Deviation 0.2227 |