ORIGINAL ARTICLE Determination of the survival rate in patients with congestive heart failure stratified by 123 I-MIBG imaging: a meta-analysis from the studies performed in Japan Yoichi Kuwabara • Nagara Tamaki • Tomoaki Nakata • Shohei Yamashina • Junichi Yamazaki Received: 30 April 2010 / Accepted: 17 September 2010 / Published online: 6 January 2011 Ó The Japanese Society of Nuclear Medicine 2010 Abstract Background The goals of this meta-analysis were to determine survival rates in patients with heart failure (HF) assessed by 123 I-MIBG imaging results using recently published studies and to determine the prognostic value of 123 I-MIBG imaging. Methods We reviewed published cohort studies carried out in Japan that compared the prognosis of patients with their 123 I-MIBG activity quantified as late heart-to-mediastinum ratio (H/M) or washout rate by performing a PubMed search for articles in English up to December 2006. Studies were selected if they analyzed a clearly defined lethal outcome (cardiovascular death) using life tables to estimate the odds ratio at 24 months after enrollment. Results Of 158 articles related to cardiac 123 I-MIBG, seven referred to studies that met the inclusion criteria: 5 evaluated H/M via 123 I-MIBG in a total of 866 patients and 4 calculated washout rate in a total of 491 patients. A low H/M indicated a high risk of cardiac death: pooled odds ratio, 5.2; 95% confidence interval (CI) of 3.1–5.7. A high washout was also associated with lethal events with a pooled odds ratio of 2.8 (CI: 1.6–5.0). The association between washout and cardiac death was heterogeneous (Chi-square = 11.0, P \ 0.02), whereas that between late H/M and fatal events was homogeneous (Chi-square = 2.3, P = no significance). Conclusion This meta-analysis of published studies of 123 I-MIBG studies conducted in Japan indicated that both a decreased cardiac 123 I-MIBG activity (H/M) and an increased washout rate are indicative of a poor prognosis in patients with chronic heart failure. Keywords Meta-analysis Á 123 I-MIBG imaging Á Heart failure Á Cardiac death Introduction Congestive heart failure is a common manifestation of the terminal stage of various cardiac diseases, and an altered sympathetic nervous system has an important role in the pathogenesis of heart failure. 123 I-metaiodobenzylguani- dine ( 123 I-MIBG) is an analog of guanethidine [1–3], and retention of 123 I-MIBG in the myocardium has been found to be specific to sympathetic nerve terminals [4]. In addi- tion, the rate of 123 I-MIBG washout between the early and delayed images represents a parameter indicative of neu- rohormonal function [5–8]. Therefore, 123 I-MIBG has been used to specifically assess cardiac sympathetic innervation and function in clinical settings and to assess the severity and clinical outcomes of heart failure. There are a number of investigations that show diagnostic or prognostic efficacies of cardiac sympathetic dysfunction Y. Kuwabara Department of Cardiovascular Medicine, Chiba University, Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan N. Tamaki Department of Nuclear Medicine, Graduate School of Medicine, Hokkaido University, Kita 15 Nishi 7, Kita-ku, Sapporo 060-8638, Japan T. Nakata Department of Cardiology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo 060-8543, Japan S. Yamashina Á J. Yamazaki (&) Department of Cardiovascular Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan e-mail: yamasaki@med.toho-u.ac.jp 123 Ann Nucl Med (2011) 25:101–107 DOI 10.1007/s12149-010-0452-0