123 I-mIBG intherisk stratifcation ofsudden cardiac death inchronic heart failure

Chronic heart failure (CHF) is a life-threatening disease with a growing incidence. This growing incidence is related to increased life expectancy, improvement of survival after myocardial infarction and better treatment options for heart failure (HF). As a consequence, the costs related to HF care will increase. Despite huge improvements in treatment, the prognosis remains unfavourable with high one-year mortality rates. The introduction of implantable devices such as implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) has improved the overall survival of patients with chronic heart failure. However, after ICD implantation for primary prevention in heart failure a high percentage of patients never have appropriate ICD discharges. In addition, 25-50% of CRT patients have no therapeutic effect. Moreover, both ICDs and CRTs are associated with malfunction and complications (e.g. inappropriate shocks, infection). Last but not least is the relatively high cost of these devices. Therefore, it is essential, not only from a clinical but also from a socioeconomic point of view, to optimise the current selection criteria for ICD and CRT. This chapter focusses on the role of 123I-meta-iodobenzylguanidine (123I-mIBG) assessed cardiac sympathetic hyperactivity in CHF. In the past decade cardiac 123I-mIBG scintigraphy has been shown to be useful in prognostication of CHF. Recently, an 123I-mIBG risk score has been developed and seems to be a promising tool to better identify CHF patients who will benefit from ICD implantation.