Cardiac neuronal imaging: Application in the evaluation of cardiac disease

Maureen M. Henneman MD, Frank M. Bengel MD, Ernst E. van der Wall MD, PhD, Juhani Knuuti MD, PhD, Jeroen J. Bax MD, PhD
Review Articles
Volume 15, Issue 3 / May , 2008

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Conclusion

The sympathetic nervous system plays an important role in cardiovascular physiology. Both SPECT with MIBG and PET can be used to visualize the sympathetic innervation of the heart and the abnormalities in innervation caused by, for example, ischemia, heart failure, and arrhythmogenic disorders. Furthermore, cardiac neuronal imaging allows early detection of autonomic neuropathy in diabetes mellitus. Although SPECT imaging is widely available and technically less demanding than PET, the latter has important advantages. PET can be used to achieve high spatial and temporal resolution, as well as absolute quantification, in a noninvasive manner. It also can provide a wide range of different radiolabeled catecholamines, catecholamine analogs, and receptor ligands. It should be noted, however, that most experience has been obtained with SPECT and MIBG.

Assessment of sympathetic nerve activity in patients with heart failure has been shown to provide important prognostic information, and cardiac neuronal imaging can potentially identify patients who are at increased risk of sudden death. Moreover, therapeutic effects of different treatment strategies can be evaluated by MIBG SPECT as well as by PET imaging. To establish the clinical utility of cardiac neuronal imaging, it will be necessary to determine the incremental value of innervation imaging to triage heart failure patients to medical therapy, CRT (with or without ICD), or heart transplantation.

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