¹²³Iodine-meta-iodobenzylguanidine (¹²³I-MIBG) imaging can visualize cardiac sympathetic innervation by providing (semi-) quantitative information on the myocardial sympathetic activity.

Although there are lots of prognostic studies in patients with heart failure, clinical application of cardiac ¹²³I-MIBG outside Japan is still limited. However, the number of potential clinical indications for ¹²³I-MIBG imaging is growing as autonomic dysfunction is also present in other cardiac diseases.

The present review gives an overview of the potential clinical cardiac indications beyond heart failure of ¹²³I-MIBG imaging to evaluate the cardiac sympathetic activity. The focus of the manuscript is primarily based on studies that have been performed outside Japan.