BACKGROUND: Cardiac sympathetic neuronal dysfunction is an early marker in wild-type transthyretin amyloidosis cardiomyopathy (ATTRwt-CM). Iodine-123-labeled norepinephrine analog meta-iodobenzylguanidine ([ METHODS: We conducted a single-center, descriptive, cross-sectional study to quantify absolute myocardial sympathetic function in ATTRwt-CM using [ RESULTS: Twenty-nine ATTRwt-CM patients (75.8 ± 6.6 years, 90% male) were prospectively included. All exhibited cardiac sympathetic neuronal dysfunction, with a median late heart-to-mediastinum ratio of 1.69 (1.45-1.89) and a washout rate of 22.7% (16.4%-27.3%). SUV CONCLUSIONS: The current study demonstrates the feasibility of volumetric quantification of [ TRIAL REGISTRATION: EudraCT ref. 2020-003350-72, retrospectively registered March 20, 2023. https://classic. CLINICALTRIALS: gov/ct2/show/NCT05776212.