Cardiac Sympathetic Innervation Imaging with PET Radiotracers
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NUCLEAR CARDIOLOGY (V DILSIZIAN, SECTION EDITOR)
Cardiac Sympathetic Innervation Imaging with PET Radiotracers Pieter van der Bijl 1 & Juhani Knuuti 2 & Victoria Delgado 1 & Jeroen J. Bax 1 Accepted: 11 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The present article reviews the pathophysiology of cardiac sympathetic denervation, the principles of positron emission tomography (PET) imaging of the sympathetic innervation of the heart and its potential clinical role, based on current and expected future evidence. Recent Findings Imaging of cardiac sympathetic denervation can be performed with radiolabeled noradrenaline analogues, e.g., 11 C-hydroxyephedrine. A greater burden of sympathetic denervation carries prognostic significance, e.g., in patients with ischemic cardiomyopathy and a left ventricular ejection fraction ≤ 35%, who are more likely to experience sudden cardiac death. Abnormalities of sympathetic cardiac innervation have been demonstrated in hypertrophic, dilated, and arrhythmic right ventricular cardiomyopathies, and may be helpful in better phenotyping patients who will benefit from device therapy, e.g., cardiac resynchronization and implantable cardioverter-defibrillator implantation. The results of future trials, e.g., the Prediction of Arrhythmic Events with Positron Emission Tomography (PAREPET) II study, are awaited to inform on the role of PET cardiac sympathetic imaging in the selection of device therapy. Summary PET cardiac sympathetic innervation imaging allows visualization and quantification of autonomic denervation secondary to various cardiac diseases, and has significant potential to influence clinical decision-making, e.g., the titration of pharmacotherapy and more directed selection of candidates for device implantation. Keywords Cardiac imaging . PET . Sympathetic innervation
Introduction Cardiac sympathetic innervation plays an important role in homeostasis, and can be dysregulated by various disease processes, e.g., myocardial infarcts and cardiac failure. Imaging of cardiac sympathetic innervation in health and disease can be performed with positron emission tomography (PET) by
using various radiotracers, and has been shown to be of prognostic value, e.g., for the prediction of sudden cardiac death (SCD). The visualization of cardiac sympathetic innervation by means of PET radiotracers also has potential in precision medicine, e.g., for SCD risk-stratification and the identification of implantable cardioverter-defibrillator (ICD) candidates.
This article is part of the Topical Collection on Nuclear Cardiology * Jeroen J. Bax [email protected] Pieter van der Bijl [email protected] Juhani Knuuti [email protected] Victoria Delgado [email protected] 1
Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
2
Turku PET Center, Turku University Hospital, Turku, Finland
(Patho)Physiology of Cardiac Sympathetic Innervation The sympathe
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