Prognostic Value of Cardiac Sympathetic Nerve Imaging Using Long-Term Follow-up Data

Subjects Individual datasets from 6 prospective MIBG cohort studies performed in Japan between 1990 and 2009 were combined to make a pooled database of 1,322 chronic HF patients, as previously reported.4 Patients with HF from 6 Japanese medical institutions provided data for this study. All patients were enrolled in prospective observational studies, in which MIBG was approved for clinical use in Japan.15,16 All the original cohort studies were approved by the ethics committee or institutional review board in each hospital, and informed consent mong the various cardiac imaging modalities, 123I-metaiodobenzylguanidine (MIBG) imaging has the unique feature of visualizing sympathetic nervous function. MIBG has a similar mechanism to norepinephrine uptake, storage and release in the nerve endings.1 Increased tone of cardiac sympathetic nerve activity impaires MIBG uptake, corresponding to increased spill-over and deficiency of norepinephrine. This cardiac sympathetic nerve dysfunction is associated with increased occurrence of unfavorable cardiac events, including pump failure and lethal cardiac arrhythmia. Recent propective and meta-analytic studies using MIBG scintigraphy in North America, Europe, and Japan have shown that it can predict cardiac death and fatal arrhythmia.2–5 In ischemic heart failure (HF), the prognostic value of myocardial perfusion imaging has been well established.6–8 Although there are several known prognostic determinants of HF, individual risk profiles can vary, in particular between ischemic and non-ischemic HF background. These differences between ischemic profiles have not been investigated as yet in longterm prognostic studies.9–14 A