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Abdominal obesity, and not general obesity, is associated with a lower 123I MIBG heart-to-mediastinum ratio in heart failure patients with preserved ejection fraction



The relationship between general obesity or abdominal obesity (abdominal circumference of ≥85 cm in men and ≥ 90 cm in women) and the heart-to-mediastinum ratio (HMR), a measure of cardiac sympathetic innervation, on cardiac iodine-123-metaiodobenzylguanidine scintigraphy (MIBG) in patients with heart failure with preserved ejection fraction (HFpEF) has not been clarified.


A total of 239 HFpEF patients with both MIBG and abdominal circumference data were examined. We divided these patients into those with abdominal obesity and those without it. In the cardiac MIBG study, early phase image was acquired 15–20 min after injection, and late phase image was acquired 3 h after the early phase. A HMR obtained from a low-energy type collimator was converted to that obtained by a medium-energy type collimator.


Early and late HMRs were significantly lower in those with abdominal obesity, although washout rates were not significantly different. The incidence of patients with early and late HMRs <2.2 was significantly higher in those with abdominal obesity. Multivariate linear regression analysis revealed that abdominal obesity was independently associated with early HMR (standardized β = −0.253, P = 0.003) and late HMR (standardized β = −0.222, P = 0.010). Multivariate logistic regression analysis revealed that abdominal obesity was independently associated with early (odds ratio [OR] [95% confidence interval {CI}] = 4.25 [2.13, 8.47], P < 0.001) and late HMR < 2.2 (OR [95% CI] = 2.06 [1.11, 3.83], P = 0.022). Elevated BMI was not significantly associated with low early and late HMR. The presence of abdominal obesity was significantly associated with low early and late HMR even in patients without elevated BMI values.


Abdominal obesity, but not general obesity, in HFpEF patients was independently associated with low HMR, suggesting that visceral fat may contribute to decreased cardiac sympathetic activity in patients with HFpEF.

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The authors thank Nagisa Yoshioka, Kyoko Tatsumi, Satomi Kishimoto, Noriko Murakami, and Sugako Mitsuoka for their excellent assistance with data collection. We thank Libby Cone, MD, MA, from DMC Corp. ( <>) for editing a draft of this manuscript.

The OCVC-Heart Failure Investigators: Shunsuke Tamaki, Tetsuya Watanabe, and Takahisa Yamada, Osaka General Medical Center, Osaka, Japan; Takaharu Hayashi and Yoshiharu Higuchi, Osaka Police Hospital, Osaka, Japan; Masaharu Masuda, Mitsutoshi Asai, and Toshiaki Mano, Kansai Rosai Hospital, Amagasaki, Japan; Hisakazu Fuji, Kobe Ekisaikai Hospital, Kobe, Japan; Daisaku Masuda, Yoshihiro Takeda, Yoshiyuki Nagai, and Shizuya Yamashita, Rinku General Medical Center, Izumisano, Japan; Masami Sairyo, Yusuke Nakagawa and Shuichi Nozaki, Kawanishi City Hospital, Kawanishi, Japan; Haruhiko Abe, Yasunori Ueda, Masaaki Uematsu, and Yukihiro Koretsune, National Hospital Organization Osaka National Hospital, Osaka, Japan; Kunihiko Nagai, Ikeda Municipal Hospital, Ikeda, Japan; Masamichi Yano, Masami Nishino, and Jun Tanouchi, Osaka Rosai Hospital, Sakai, Japan; Yoh Arita and Shinji Hasegawa, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan; Takamaru Ishizu, Minoru Ichikawa and Yuzuru Takano, Higashiosaka City Medical Center, Higashiosaka, Japan; Eisai Rin, Kawachi General Hospital, Higashiosaka, Japan; Yukinori Shinoda and Shiro Hoshida, Yao Municipal Hospital, Yao, Japan; Masahiro Izumi, Kinki Central Hospital, Itami, Japan; Hiroyoshi Yamamoto and Hiroyasu Kato, Japan Community Health Care Organization, Osaka Minato Central Hospital, Osaka, Japan; Kazuhiro Nakatani and Yuji Yasuga, Sumitomo Hospital, Osaka, Japan; Mayu Nishio and Keiji Hirooka, Saiseikai Senri Hospital, Suita, Japan; Takahiro Yoshimura and Yoshinori Yasuoka, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Japan; Akihiro Tani, Kano General Hospital, Osaka, Japan; Yasushi Okumoto and Hideharu Akagi, Kinan Hospital, Tanabe, Japan; Yasunaka Makino, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan; Toshinari Onishi and Katsuomi Iwakura, Sakurabashi Watanabe Hospital, Osaka, Japan; Nagahiro Nishikawa and Yoshiyuki Kijima, Japan Community Health Care Organization, Hoshigaoka Medical Center, Hirakata, Japan; Takashi Kitao and Hideyuki Kanai, Minoh City Hospital, Minoh, Japan; Wataru Shioyama and Masashi Fujita, Osaka International Cancer Institute, Osaka, Japan; Koichiro Harada, Suita Municipal Hospital, Suita, Japan; Masahiro Kumada and Osamu Nakagawa, Toyonaka Municipal Hospital, Toyonaka, Japan; Ryo Araki and Takayuki Yamada, Otemae Hospital, Osaka, Japan; Akito Nakagawa and Yoshio Yasumura, Amagasaki Chuo Hospital, Amagasaki, Japan; and Taiki Sato, Akihiro Sunaga, Bolrathanak Oeun, Hirota Kida, Takayuki Kojima, Yohei Sotomi, Tomoharu Dohi, Kei Nakamoto, Katsuki Okada, Fusako Sera, Shinichiro Suna, Hidetaka Kioka, Tomohito Ohtani, Toshihiro Takeda, Daisaku Nakatani, Hiroya Mizuno, Shungo Hikoso, Yasushi Matsumura and Yasushi Sakata, Osaka University Graduate School of Medicine, Suita, Japan.

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This study was funded by Roche diagnostic and FUJIFILM Toyama Chemical.

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Authors and Affiliations




Akihiro Sunaga: conceptualization, formal analysis, investigation, methodology, project administration, visualization, writing—original draft. Shungo Hikoso: project administration, supervision, writing—review & editing. Takahisa Yamada: resources, supervision, writing—review & editing. Yoshio Yasumura, resources, writing—review & editing. Masaaki Uematsu; Resources, writing—review & editing. Haruhiko Abe; Resources, writing—review & editing. Yusuke Nakagawa, Resources, writing—review & editing. Yoshiharu Higuchi: resources, writing—review & editing. Hisakazu Fuji; Resources, writing—review & editing. Toshiaki Mano; Resources, writing—review & editing. Hiroyuki Kurakami: data curation, formal analysis. Tomomi Yamada: data curation, formal analysis. Tetsuhisa Kitamura: writing—review & editing. Taiki Sato: writing—review & editing. Bolrathanak Oeun: writing—review & editing. Hirota Kida: writing—review & editing. Takayuki Kojima; writing—review & editing. Yohei Sotomi: data curation, writing—review & editing. Tomoharu Dohi: writing—review & editing. Katsuki Okada: writing—review & editing. Shinichiro Suna: writing—review & editing. Hiroya Mizuno: writing—review & editing. Daisaku Nakatani: writing—review & editing. Yasushi Sakata: funding acquisition, project administration, supervision, writing—review & editing.

Corresponding author

Correspondence to Shungo Hikoso.

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Ethics approval

The protocol was approved by the Institutional Review Board (IRB) of Osaka University Hospital on 24 February 2016 (ID: 15471), and by the IRBs of the all participating facilities.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Consent for publication was obtained from all individual participants included in the study.

Conflict of interest

Shungo Hikoso has received remuneration from Daiichi Sankyo Company, and received research funding from Roche Diagnostics, FUJIFILM Toyama Chemical, and Actelion Pharmaceuticals. Yoshiharu Higuchi has received remuneration from Daiichi Sankyo Company. Hiroya Mizuno has received endowed department from Terumo. Yohei Sotomi has received remuneration from Abbott Vascular Japan, Boston Scientific Japan, and received research funding from Abbott Vascular Japan, and endowed department form Terumo. Yasushi Sakata received remuneration from Otsuka Pharmaceutical, Ono Pharmaceutical, Daiichi Sankyo Company and AstraZeneca K.K., and received research funding form Otsuka Pharmaceutical, Daiichi Sankyo Company, Mitsubishi Tanabe Pharma Corporation, Astellas Pharma, Kowa Company, Boehringer Ingelheim Japan, and Biotronik. The other authors have nothing to declare.

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Sunaga, A., Hikoso, S., Yamada, T. et al. Abdominal obesity, and not general obesity, is associated with a lower 123I MIBG heart-to-mediastinum ratio in heart failure patients with preserved ejection fraction. Eur J Nucl Med Mol Imaging 49, 609–618 (2022).

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  • Heart failure
  • Preserved ejection fraction
  • Iodine-123-metaiodobenzylguanidine scintigraphy
  • Heart to mediastinum ratio
  • Abdominal obesity
  • Abdominal circumference