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Imaging Sympathetic Innervation of the Heart: Therapeutic Strategies SPECT/CT and PET/CT

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Autonomic Innervation of the Heart

Abstract

Tracers for radionuclide imaging of cardiac neurotransmission have been developed by radiolabeling true neurotransmitters or corresponding structural analogs (false neurotransmitters). The most commonly used radiopharmaceuticals to assess cardiac neurotransmission are [11C]-metahydroxyephedrine ([11C]-mHED), [11C]-ephedrine, [18F]-dopamine, and [123I]-metaiodobenzylguanidine ([123I]-MIBG), which estimate neuronal presynaptic reuptake (type I uptake) and storage of norepinephrine (NE).

In heart failure (HF), there is impairment of the neuronal uptake of NE in the myocardium due to chronic sympathetic activation. Reduced myocardial uptake of these radiotracers is an indicator of poor prognosis for HF patients. Cardiac adrenergic imaging might be useful as an indicator of whether or not the HF patient’s medical therapy is effective and could therefore help determine whether higher-risk and usually more expensive device therapies or cardiac transplantation is needed.

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Abbreviations

ACEI:

Angiotensin-converting enzyme inhibitor

ARB:

Angiotensin receptor blocker

BMC:

Bone marrow cell

BNP:

Brain natriuretic peptide

CAD:

Coronary artery disease

CRT:

Cardiac resynchronization therapy

DCM:

Dilated cardiomyopathy

DM:

Diabetes mellitus

ECG:

Electrocardiogram

EF:

Ejection fraction

EPS:

Electrophysiological studies

HF:

Heart failure

HMR:

Heart to mediastinum ratio

HRV:

Heart rate variability

ICD:

Implantable cardioverter defibrillator

LBBB:

Left bundle branch block

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

MRA:

Mineralocorticoid receptor antagonists

MUGA:

Multiple gated acquisition

NE:

Norepinephrine

NPV:

Negative predictive value

NYHA:

New York Heart Association

PET:

Positron emission tomography

RBBB:

Right bundle branch block

SCA:

Sudden cardiac arrest

SCD:

Sudden cardiac death

SPECT:

Single-photon emission computed tomography

STEMI:

ST-segment elevation myocardial infarct

VT:

Ventricular tachycardia

WR:

Washout rate

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Authors and Affiliations

  1. Cardiovascular Physiology, Universidad Nacional Autónoma de México, Ciudad de México, Mexico

    Erick Alexanderson MD

  2. Nuclear Cardiology Department, Instituto Nacional de Cardiología “Ignacio Chávez”, Ciudad de México, Mexico

    Erick Alexanderson MD

  3. Nuclear Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

    Albert Flotats MD

  4. Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Albert Flotats MD

  5. Unidad PET/CT Ciclotrón, Universidad Nacional Autónoma de México, Ciudad de México, Mexico

    Luis Eduardo Juárez-Orozco MD

  6. Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Luis Eduardo Juárez-Orozco MD

Authors
  1. Erick Alexanderson MD
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  2. Albert Flotats MD
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  3. Luis Eduardo Juárez-Orozco MD
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Correspondence to Erick Alexanderson MD .

Editor information

Editors and Affiliations

  1. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Riemer H.J.A. Slart

  2. Thorax center Cardiology, University Medical Center Groningen, Groningen, The Netherlands

    René A. Tio

  3. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Philip H. Elsinga

  4. Nuklearmedizinische Klinik, Klinikum Rechts der Isar Technische Universität München, München, Germany

    Markus Schwaiger

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Alexanderson, E., Flotats, A., Juárez-Orozco, L.E. (2015). Imaging Sympathetic Innervation of the Heart: Therapeutic Strategies SPECT/CT and PET/CT. In: Slart, R., Tio, R., Elsinga, P., Schwaiger, M. (eds) Autonomic Innervation of the Heart. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45074-1_19

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  • DOI: https://doi.org/10.1007/978-3-662-45074-1_19

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