Heart Failure Risk: Can a Simple Scan Predict Your Odds?
"Revolutionary heart scan could help doctors identify low-risk patients and prevent unnecessary procedures."
Heart failure is a serious condition, affecting millions worldwide. While treatments like implantable cardioverter-defibrillators (ICDs) can be life-saving, they're not always necessary. In fact, about 80% of people who receive an ICD never actually need it.
That's why doctors are searching for better ways to identify who truly benefits from an ICD and who might be at lower risk. A new study published in the Journal of Nuclear Cardiology suggests that a special type of heart scan, called iodine-123 meta-iodobenzylguanidine (123I-mIBG) scintigraphy, could be the key.
This article breaks down the findings of this study, explaining how the 123I-mIBG scan works, what the results mean for people with heart failure, and why this could lead to more personalized and effective treatment strategies.
Heart failure’s growing U.S. burden
The HF Stats 2025 report estimates that approximately 6.7 million Americans over age 20 have heart failure, a number projected to reach 8.7 million by 2030. In 2022, heart failure contributed to 425,147 deaths and accounted for 45% of U.S. cardiovascular deaths. HF Stats 2026 reports a 24% lifetime risk—nearly 1 in 4 Americans—and says about one-third of U.S. adults without symptomatic heart failure meet Stage A criteria, with a further 24–34% in Stage B. The HF Stats 2025 report also notes that the share of people with three cardiovascular-kidney-metabolic conditions more than doubled between 1999–2002 and 2015–2020.
The 123I-mIBG Scan: A Window into Your Heart's Health
The 123I-mIBG scan isn't your typical heart test. It's designed to look at the neuroadrenergic function of your heart.
- How it works: A small amount of radioactive tracer is injected into your bloodstream. This tracer is absorbed by the heart's nerve cells.
- The Scan: Using a special camera, doctors can then see how much of the tracer is taken up by the heart and how quickly it's cleared away.
- What it Reveals: This information provides valuable insights into the health of your heart's nervous system.
Imaging toward more tailored heart failure care
A 2026 narrative review surveys how advanced cardiac imaging and artificial intelligence may contribute across pre-procedural, intra-procedural, and post-procedural stages of heart failure interventions. A 2026 review describes heart failure as a heterogeneous syndrome that calls for clarification of its cause, placing cardiac imaging at the center of that assessment. Earlier work on 123I-MIBG cardiac sympathetic imaging reported that, in a substantial portion of treated systolic heart failure patients, declining left ventricular ejection fraction accompanied progressive impairment of cardiac sympathetic activation. That study also described rising circulating epinephrine and norepinephrine as responses aimed at sustaining cardiac stroke volume as systolic function declines.
Imaging requires a tailored diagnostic strategy
Cardiac imaging is central to diagnosing heart failure and investigating its cause, but the many available modalities and structural and functional measures can make it challenging to choose an accurate strategy without wasting resources. Echocardiography remains a cornerstone of assessment, while strain imaging can improve diagnostic sensitivity, risk stratification, and early detection of myocardial dysfunction. Diastolic-function assessment and strain can provide additional diagnostic clues; one example cited is the very low E and e′ values often seen in hypertrophic cardiomyopathy because of severely disturbed relaxation, especially in the hypertrophied septum. Advanced imaging can also provide functional, hemodynamic, and tissue characterization beyond noninvasive estimates of cardiac volumes.
The Future of Heart Failure Treatment: Personalized and Precise
This study adds to a growing body of evidence that the 123I-mIBG scan can be a valuable tool for identifying heart failure patients at low risk of dangerous events. For those individuals, an ICD may not be necessary, avoiding the risks and costs associated with the device.
Imaging can reveal disease before symptoms
Heart failure guidelines emphasize identifying the condition in subclinical stages to address risk factors and help prevent progression to symptomatic disease. Stage A includes people with heart failure risk factors but no cardiac abnormalities, while Stage B involves evidence of structural, functional, or biomarker abnormalities. A reported acute heart failure case illustrates how cardiac magnetic resonance can add detail: the images showed severe left ventricular dilation with hypertrabeculation, T2-weighted images excluded edema, and diffuse endocardial late enhancement was compatible with endomyocardial disease. The source describes CMR as crucial for assessment.
However, it's important to remember that this is just one piece of the puzzle. Doctors should consider all available information, including other tests and your overall health, when making treatment decisions.
As research continues, we can expect even more precise and personalized approaches to heart failure treatment, ensuring that the right people get the right therapies at the right time.