Cardiac innervation imaging as a risk stratification tool for potential device therapy candidates

As a scintigraphic approach evaluating cardiac nerve integrity, ¹²³I-metaiodobenzylguanidine (¹²³I-mIBG) has been recently Food and Drug Administration approved. A great deal of progress has been made by the prospective ADMIRE-HF trial, which primarily demonstrated the association of denervated myocardium assessed by ¹²³I-mIBG and cardiac events. However, apart from risk stratification, myocardial nerve function evaluated by molecular imaging should also be expanded to other clinical contexts, in particular to guide the referring cardiologist in selecting appropriate candidates for specific therapeutic interventions. In the present issue of the Journal of Nuclear Cardiology^®, the use of ¹²³I-mIBG for identifying cardiomyopathy patients, which would most likely not benefit from ICD due to low risk of arrhythmias, is described. If we aim to deliver on the promise of cardiac innervation imaging as a powerful tool for risk stratification in a manner similar to nuclear oncology, studies such as the one reviewed here may imply an important step to lay the proper groundwork for a more widespread adoption in clinical practice.