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<p>While sympathetic overactivity is a well-established driver of disease progression in heart failure with reduced ejection fraction, its role in early-stage heart failure with preserved ejection fraction (HFpEF) remains unclear. In particular, renal sympathetic activity—an important contributor to neurohormonal dysregulation—has not been systematically evaluated in HFpEF. Early-stage HFpEF refers to patients who present with mild symptoms, only modest elevations in B-type natriuretic peptide (BNP), and invasively confirmed elevated left ventricular end-diastolic pressure (LVEDP) but without overt structural remodeling or severe congestion. We conducted a single-center retrospective randomized controlled study including 121 patients with early-stage HFpEF and 44 matched controls. All participants underwent <sup>131</sup>I-metaiodobenzylguanidine (<sup>131</sup>I-MIBG) scintigraphy to quantify sympathetic nerve activity in the heart and kidneys. Uptake ratios (15&#xa0;min and 4&#xa0;h heart-to-mediastinum [H/Ma] and kidney-to-posterior mediastinum [K/Mp]) and washout rates (Heart Washout Rate [HWR] and Kidney washout Rate [KWR]) were calculated. Correlations with these MIBG parameters and left ventricular end-diastolic pressure (LVEDP) were analyzed. HFpEF patients showed significantly higher cardiac H/Ma and renal K/Mp ratios, and lower HWR and KWR compared with controls (all <i>P</i> &lt; 0.001). In the HFpEF group, both 4-h H/Ma and 4-h K/Mp ratios were positively correlated with LVEDP, while HWR and KWR were inversely correlated with these indices (all <i>P</i> &lt; 0.01). Early-stage HFpEF patients show increased cardiac and renal sympathetic activity, highlighting the renal sympathetic nervous system as a potential therapeutic target and suggesting <sup>131</sup>I-MIBG scintigraphy as a promising tool for risk stratification and early intervention.</p> Graphical abstract <p><sup>131</sup>I-MIBG imaging reveals heightened cardiac and renal sympathetic nerve activity in early-stage HFpEF, with H/Ma and K/Mp positively and HWR and KWR inversely correlated with LVEDP, highlighting early autonomic dysregulation and potential for risk stratification.</p> <p></p>

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Cardiac and renal sympathetic nerve activation in early-stage HFpEF: insights from 131I-MIBG imaging study

  • 期刊论文

  • 发表日期：

    2025年12月12日

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  • Meijing Shi,
  • Zhiqiang Yang,
  • Pei Yin,
  • Huayi Zhao,
  • Lizhuo Li,
  • Yuzhi Zhen,
  • Qingzhen Zhao,
  • Chao Liu

摘要

While sympathetic overactivity is a well-established driver of disease progression in heart failure with reduced ejection fraction, its role in early-stage heart failure with preserved ejection fraction (HFpEF) remains unclear. In particular, renal sympathetic activity—an important contributor to neurohormonal dysregulation—has not been systematically evaluated in HFpEF. Early-stage HFpEF refers to patients who present with mild symptoms, only modest elevations in B-type natriuretic peptide (BNP), and invasively confirmed elevated left ventricular end-diastolic pressure (LVEDP) but without overt structural remodeling or severe congestion. We conducted a single-center retrospective randomized controlled study including 121 patients with early-stage HFpEF and 44 matched controls. All participants underwent 131I-metaiodobenzylguanidine (131I-MIBG) scintigraphy to quantify sympathetic nerve activity in the heart and kidneys. Uptake ratios (15 min and 4 h heart-to-mediastinum [H/Ma] and kidney-to-posterior mediastinum [K/Mp]) and washout rates (Heart Washout Rate [HWR] and Kidney washout Rate [KWR]) were calculated. Correlations with these MIBG parameters and left ventricular end-diastolic pressure (LVEDP) were analyzed. HFpEF patients showed significantly higher cardiac H/Ma and renal K/Mp ratios, and lower HWR and KWR compared with controls (all P < 0.001). In the HFpEF group, both 4-h H/Ma and 4-h K/Mp ratios were positively correlated with LVEDP, while HWR and KWR were inversely correlated with these indices (all P < 0.01). Early-stage HFpEF patients show increased cardiac and renal sympathetic activity, highlighting the renal sympathetic nervous system as a potential therapeutic target and suggesting 131I-MIBG scintigraphy as a promising tool for risk stratification and early intervention.

Graphical abstract

131I-MIBG imaging reveals heightened cardiac and renal sympathetic nerve activity in early-stage HFpEF, with H/Ma and K/Mp positively and HWR and KWR inversely correlated with LVEDP, highlighting early autonomic dysregulation and potential for risk stratification.