{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T21:39:29Z","timestamp":1774474769194,"version":"3.50.1"},"reference-count":65,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,5]],"date-time":"2022-06-05T00:00:00Z","timestamp":1654387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>In chronic heart failure (CHF), abnormalities in cardiac autonomic control, characterized by sympathetic overactivity, contribute to the progression of the disease and are associated with an unfavorable prognosis. Assessing cardiac autonomic status is clinically important in the management of patients with CHF. To this aim, heart rate variability (HRV) analysis has been extensively used as a non-invasive tool for assessing cardiac autonomic regulation, and has been shown to predict the clinical outcome in patients with CHF. Adrenergic nerve activity has also been estimated using iodine-123 (I-123) metaiodobenzylguanidine (MIBG), a noradrenaline analogue. MIBG is an analogue of norepinephrine sharing the same cellular mechanism of uptake, storage, and release in presynaptic sympathetic neurons. As an innervation tracer, 123I-MIBG allows for the evaluation of cardiac sympathetic neuronal function. Cardiac MIBG imaging has also been reported to predict a poor clinical outcome in CHF. MIBG provides direct information on the function of the presynaptic sympathetic nerve endings, whereas HRV, which depends on postsynaptic signal transduction, reflects the end-organ response of the sinus node. The aim of this brief review is to provide the reader with some basic concepts regarding the spectral analysis of HRV and MIBG, highlighting what is known about their respective roles in detecting cardiac sympathetic hyperactivity in CHF and, in perspective, their possible combined use in assessing non-pharmacological treatments in patients with CHF and reduced ejection fraction, with a particular focus on the effects of exercise training.<\/jats:p>","DOI":"10.3390\/jcdd9060181","type":"journal-article","created":{"date-parts":[[2022,6,5]],"date-time":"2022-06-05T10:47:11Z","timestamp":1654426031000},"page":"181","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Complementary Role of Combined Indirect and Direct Cardiac Sympathetic (Hyper)Activity Assessment in Patients with Heart Failure by Spectral Analysis of Heart Rate Variability and Nuclear Imaging: Possible Application in the Evaluation of Exercise Training Effects"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8421-5065","authenticated-orcid":false,"given":"Ferdinando","family":"Iellamo","sequence":"first","affiliation":[{"name":"Department of Cardiology and Sports Medicine, University of Rome Tor Vergata, 00133 Rome, Italy"},{"name":"Cardiology Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS San Raffaele Pisana, 00163 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0511-2621","authenticated-orcid":false,"given":"Marco Alfonso","family":"Perrone","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Sports Medicine, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0533-2947","authenticated-orcid":false,"given":"Andrea","family":"Cimini","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7820-567X","authenticated-orcid":false,"given":"Giuseppe","family":"Caminiti","sequence":"additional","affiliation":[{"name":"Cardiology Rehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS San Raffaele Pisana, 00163 Rome, Italy"},{"name":"Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, 00163 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agostino","family":"Chiaravalloti","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy"},{"name":"Nuclear Medicine Section, IRCCS Neuromed, 86077 Pozzilli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2648-8406","authenticated-orcid":false,"given":"Attilio","family":"Parisi","sequence":"additional","affiliation":[{"name":"Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orazio","family":"Schillaci","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy"},{"name":"Nuclear Medicine Section, IRCCS Neuromed, 86077 Pozzilli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"72A","DOI":"10.1016\/0735-1097(93)90466-E","article-title":"Clinical aspects of sympathetic activation and parasympathetic withdrawal in heart failure","volume":"22","author":"Floras","year":"1993","journal-title":"J. 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