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Objectives: The aim of this study was to determine whether (11)C-hydroxyephedrine ((11)C-HED) can predict adverse events including all-cause death in Japanese patients with left ventricular (LV) dysfunction. Background: Although (11)C-HED PET has been used to assess cardiac sympathetic innervation in various disease conditions, data on their prognostic value are limited. Methods: Sixty patients (mean LVEF, 42 ± 14 %) with LV dysfunction (42 ischemic and 18 non-ischemic heart disease) underwent (11)C-HED PET. Myocardial retention was calculated for (11)C-HED PET as a measure of cardiac sympathetic neuronal integrity. Statistical analysis was performed using Cox proportional hazards regression and log-rank test. Results: Thirteen deaths (7 cardiac and 6 non-cardiac deaths) occurred during a mean follow-up period of 33 ± 23 months. The patients with death were associated with significantly lower (11)C-HED retention (7.1 ± 2.1 vs 9.0 ± 2.4, p = 0.015) than those without death. The hazard ratio for global (11)C-HED retention per unit (/min) was 0.762 (p = 0.039), which remained significant in multivariate analysis. When the patients were divided into the high (≥8.5) and low (<8.5) (11)C-HED retention groups, the low (11)C-HED retention group was associated with significantly poorer survival than the high (11)C-HED retention group (p = 0.004). Conclusion: The low global (11)C-HED retention is a marker of poor overall survival in patients with LV dysfunction in this study. [ABSTRACT FROM AUTHOR]