Prognostic usefulness of planar 123I-MIBG scintigraphic images of myocardial sympathetic innervation in congestive heart failure: Follow-Up data from ADMIRE-HF

J Nucl Cardiol. 2021 Aug;28(4):1490-1503. doi: 10.1007/s12350-019-01859-w. Epub 2019 Aug 29.


Background: To evaluate whether planar 123I-MIBG myocardial scintigraphy predicts risk of death in heart failure (HF) patients up to 5 years after imaging.

Methods and results: Subjects from ADMIRE-HF were followed for approximately 5 years after imaging (964 subjects, median follow-up 62.7 months). Subjects were stratified according to the heart/mediastinum (H/M) ratio (< 1.60 vs ≥ 1.60) on planar 123I-MIBG scintigraphic images obtained at baseline in ADMIRE-HF. Cox proportional hazards models and Kaplan-Meier analyses were used to evaluate time to death, cardiac death, or arrhythmic events for subjects stratified by H/M ratio, baseline left ventricular ejection fraction (LVEF: < 25% and 25 to ≤ 35%), and by H/M strata within LVEF strata. All-cause mortality was 38.4% vs 20.9% and cardiac mortality was 16.8% vs 4.5%, in subjects with H/M < 1.60 vs ≥ 1.60, respectively (P < 0.05 for both comparisons). Subjects with preserved sympathetic innervation of the myocardium (H/M ≥ 1.60) were at significantly lower risk of all-cause and cardiac death, arrhythmic events, sudden cardiac death, or potentially life-threatening arrhythmias. Within LVEF strata, a trend toward a higher mortality for subjects with H/M < 1.60 was observed reaching significance for LVEF 25 to ≤ 35% only.

Conclusions: During a median follow-up of 62.7 months, patients with H/M ≥ 1.60 were at significantly lower risk of death and arrhythmic events independently of LVEF values.

Keywords: 123I-MIBG; cardiac death; congestive heart failure; prognosis.

Publication types

  • Clinical Trial, Phase IV

MeSH terms

  • 3-Iodobenzylguanidine*
  • Aged
  • Female
  • Follow-Up Studies
  • Heart / innervation*
  • Heart Failure / diagnostic imaging*
  • Heart Failure / mortality
  • Humans
  • Iodine Radioisotopes*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Radiopharmaceuticals*
  • Stroke Volume
  • Survival Analysis
  • Sympathetic Nervous System / diagnostic imaging
  • Time Factors
  • Tomography, Emission-Computed, Single-Photon*


  • Iodine Radioisotopes
  • Radiopharmaceuticals
  • 3-Iodobenzylguanidine
  • Iodine-123