Abstract 4147215: Cardiac Magnetic Resonance Imaging vs Positron Emission Tomography in the Assessment of Viability in Ischemic Cardiomyopathy. The Alternative Imaging Modalities in Heart Failure (AIM-HF) Clinical Trial
Bibliographic record
Abstract
Background: Patients with ischemic heart failure (IHF) often undergo myocardial viability assessment to help determine the appropriate treatment strategy, whether revascularization or medical therapy. However, there is a lack of evidence regarding the optimal imaging modality for this purpose. The present study aimed to compare the clinical outcomes of IHF patients undergoing cardiac magnetic resonance (CMR) versus positron emission tomography (PET) for myocardial viability assessment. Methods: We enrolled patients >18 years with IHF and ejection fraction (EF) < 45% needing viability assessment. Exclusions included those with cardiac devices, significant medical conditions, recent ST segment myocardial infarction (<4 weeks), unsuitability for revascularization, or needing emergency revascularization/valve surgery. Patients were randomized to PET or CMR for viability detection. The primary endpoint was the composite of cardiac death, myocardial infarction, cardiac arrest, or cardiac re-hospitalization. Secondary endpoints evaluated the effect of imaging strategies on each composite component, including cardiac death. Results: Total of 116 patients were randomized to either the CMR group (n=60) or the PET group (n=56) at sites where both modalities were available. There were no significant differences between the CMR and PET groups in terms of average age (63.7±9.6 vs. 63.9±10.2), prevalence of male patients (90% vs. 89%), or NYHA class III or IV (40% vs. 38%). The mean EF was 25.5±7.9 in the CMR and 26.6±8.3 in the PET group, with a standardized difference of 0.264.Over a median (IQR) of 25.0 (15.3,29.6) months, the cumulative incidence rate (CIR) for the primary endpoint was 25.0% for CMR and 32.6% for PET (HR 0.74,CI 0.37-1.49,p=0.402).The CIR for cardiac death was 13.9% for CMR vs. 13.2% for PET (HR 1.12 (0.41,3.06,p=0.822)).(Fig.1) Conclusion: The result of this randomized cohort showed that among IHF patients who required a definition of viability, there were no significant differences in the incidence of important cardiac endpoints when either CMR or PET were used. Larger randomized clinical trials should be considered to confirm the current results.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".