Importance of individual patient characteristics when assessing the ability of cardiac adrenergic imaging to guide ICD u
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Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY
Received Sep 15, 2020; accepted Sep 15, 2020 doi:10.1007/s12350-020-02387-8
See related article, doi: https://doi.org/1 0.1007/s12350-020-02321-y
A major strength of radionuclide cardiac imaging is that its portrayal of underlying physiologic and molecular processes of cardiac disease can provide risk stratification better than other testing methods, thereby able to improve patient management. At the same time, one must consider that as with most testing modalities, clinical implications of nuclear cardiac image findings may differ depending on a patient’s clinical circumstances. With regard to myocardial perfusion imaging that is the most commonly used technique, while its strong and independent prognostic utility for patients with coronary disease has been well accepted for many years, it was recognized early in its development that prognostic implications of image findings vary depending on individual patient clinical characteristics.1 There are continuing efforts to develop nuclear cardiology techniques that assess and help manage conditions other than coronary disease, most notably heart failure (HF), a ubiquitous condition with high morbidity and mortality, expected to dramatically increase in prevalence over the next decades.2 An important component of managing HF patients is judicious use of cardiac implantable electronic devices that, while promising improved survival and quality of life, often cause significant morbidity and are expensive.
Reprint requests: Mark I. Travin, MD, MASNC, Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center and the Albert Einstein College of Medicine, 111 E. 210th Street, Bronx, NY 10467-2490; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
Among such devices is the implantable cardioverter defibrillator (ICD) used to prevent arrhythmic cardiac death in HF patients otherwise expected to have meaningful survival. While in published guidelines left ventricular ejection fraction (LVEF) is customarily the key parameter for deciding whether a HF patient should receive an ICD,3 this approach has widely recognized flaws. Being a blunt measure of LV function that misses much important information, LVEF has been characterized as ‘‘simplistic,’’ with limited ability to predict arrhythmic death.4 In one report, more than 80% of patients who received an ICD did not use it over as long as 8 years.5 ADVANTAGES OF RADIONUCLIDE CARDIAC AUTONOMIC INNERVATION IMAGING It is therefore advantageous to use parameters related to ventricular arrhythmic mechanisms for ICD patient selection. Among potential choices, cardiac adrenergic innervation imaging with 123I-mIBG or analogous positron emission tomographic (PET) tracers such as carbon-11 hydroxyephedrine (11C-HED), that more directly assess underlying arrhythmic origins, has consistently demonstrated independent abilit
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