What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic heart failure (n=1322). Intervention: 123I-MIBG imaging (delayed heart-to-mediastinum ratio) vs. Non-ischemic heart failure etiology. Primary outcome: All-cause mortality (HR 0.58, 95% CI 0.46-0.73, p=<0.0001).

What question did this study set out to answer?

This research aims to compare the prognostic value of cardiac MIBG imaging in ischemic versus non-ischemic heart failure.

April 1, 2026Open Access

Prognostic Value of Cardiac Sympathetic Nerve Imaging Using Long-Term Follow-up Data: Ischemic vs. Non-Ischemic Heart Failure Etiology

Q: What are the key findings of this study?

Delayed heart-to-mediastinum ratio on cardiac 123I-MIBG imaging independently predicted lethal events in both ischemic (HR 0.58) and non-ischemic (HR 0.61) heart failure patients.

Q: What does this research mean for the field?

Delayed heart-to-mediastinum ratio on cardiac 123I-MIBG imaging independently predicts lethal events with nearly identical prognostic value in both ischemic and non-ischemic heart failure patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

This research aims to compare the prognostic value of cardiac MIBG imaging in ischemic versus non-ischemic heart failure.

Key Result

Delayed heart-to-mediastinum ratio on cardiac 123I-MIBG imaging independently predicted lethal events in both ischemic (HR 0.58) and non-ischemic (HR 0.61) heart failure patients.

Key Points

This research aims to compare the prognostic value of cardiac MIBG imaging in ischemic versus non-ischemic heart failure.
Included 1,322 heart failure patients followed for up to 10 years
Divided patients into ischemic (362) and non-ischemic (960) groups
Utilized Cox proportional hazards model for data analysis
22.4% of patients died during the follow-up period
Ischemic group showed higher rates of sudden death and myocardial infarction
Non-ischemic group had more deaths due to pump failure
Key predictors of lethal events included heart-to-mediastinum ratio and age in both groups

Study Design

Type

Cohort (n=1,322)

Multicenter

Yes

Structured PICO

Does cardiac 123I-MIBG imaging have different prognostic value for predicting mortality in patients with ischemic versus non-ischemic heart failure?

Population

1,322 patients with chronic heart failure (LVEF ~36%), divided into ischemic (n=362, mean age 66.5, 76.8% male) and non-ischemic (n=960, mean age 59.1, 69.2% male) groups, pooled from 6 prospective cohort studies in Japan.

Intervention

Cardiac 123I-meta-iodobenzylguanidine (MIBG) imaging, specifically evaluating early and delayed heart-to-mediastinum ratio (HMR) and washout rate.

Comparator

Ischemic versus non-ischemic heart failure etiology.

Outcome

All-cause mortality (including HF death, sudden cardiac death, acute myocardial infarction, and non-cardiac death) evaluated at a mean follow-up of 77.6 months (up to 10 years).hard clinical

Cardiac MIBG imaging provides strong, independent prognostic value for predicting long-term mortality in patients with heart failure, regardless of whether the etiology is ischemic or non-ischemic.

Main Result

Effect estimate: HR 0.58 (95% CI 0.46-0.73)

Absolute Event Rate: 21.8% vs 22.6%

p-value: p=<0.0001

Limitations

BNP measurement was not available for all patients in the 1990s and could not be included in the hazard model
SPECT was not used to assess regional innervation, making it difficult to achieve regional assessment of denervated but viable myocardium
Myocardial perfusion data were not available to assess added value
Treatment strategies for heart failure changed significantly between the early 1990s and 2000s, particularly regarding beta-blocker use

Abstract

Background:Although there are several known prognostic determinants in heart failure (HF), individual risk profiles can vary, in particular between ischemic and non-ischemic HF background. This study investigated the difference in prognostic efficacy of cardiac 123I-meta-iodobenzylguanidine (MIBG) imaging between the 2 etiologies.Methods and Results:All 1,322 patients with HF were enrolled and followed up at most after 10 years. The HF patients were divided into 2 groups: an ischemic group (n=362) and non-ischemic group (n=960), and Cox proportional hazards model was used for data analysis. During 10 years of follow-up, 296 (22.4%) of 1,322 patients died; the mortality rates were 21.8% and 22.6% for the ischemic and non-ischemic groups, respectively. The ischemic group had greater prevalence of sudden death and lethal acute myocardial infarction, and the non-ischemic group had a higher rate of pump failure death. On multivariate Cox proportional hazards analysis using categorized variables, in the ischemic group, delayed heart-to-mediastinum ratio (HMR; P<0.0001), age (P=0.0002) and LVEF (P=0.03) were the independent significant predictors of lethal events. In the non-ischemic group, delayed HMR (P<0.0001), NYHA class (P<0.0001) and age (P<0.0001) were significant determinants of lethal outcome.Conclusions:Cardiac MIBG imaging has nearly identical prognostic value in both ischemic and non-ischemic HF, independent of cause of cardiac death. (Circ J 2016; 80: 435–441)

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