Nuclear Imaging of the Cardiac Sympathetic Nervous System: A Disease-Specific Interpretation in Heart Failure

Jason G E Zelt; Robert A deKemp; Benjamin H Rotstein; Girish M Nair; Jagat Narula; Ali Ahmadi; Rob S Beanlands; Lisa M Mielniczuk

doi:10.1016/j.jcmg.2019.01.042

Nuclear Imaging of the Cardiac Sympathetic Nervous System: A Disease-Specific Interpretation in Heart Failure

JACC Cardiovasc Imaging. 2020 Apr;13(4):1036-1054. doi: 10.1016/j.jcmg.2019.01.042. Epub 2019 Jul 17.

Authors

Jason G E Zelt¹, Robert A deKemp², Benjamin H Rotstein³, Girish M Nair⁴, Jagat Narula⁵, Ali Ahmadi², Rob S Beanlands¹, Lisa M Mielniczuk⁶

Affiliations

¹ Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
² Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Canada.
³ Department of Biochemistry Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
⁴ Cardiac Electrophysiologist, Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada.
⁵ Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
⁶ Molecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada. Electronic address: lmielniczuk@ottawaheart.ca.

PMID: 31326479
DOI: 10.1016/j.jcmg.2019.01.042

Abstract

Abnormalities in the cardiac sympathetic nervous system have been documented in various heart diseases and have been directly implicated in their pathogenesis and disease progression. Noninvasive techniques using single-photon-emitting radiotracers for planar scintigraphy and single-photon emission computed tomography, and positron-emitting tracers for positron emissions tomography, have been used to characterize the cardiac sympathetic nervous system with norepinephrine analogs [¹²³I]meta-iodobenzylguanidine for planar and single-photon emission computed tomography imaging and [¹¹C]meta-hydroxyephedrine for positron emissions tomography. Their usefulness in prognostication and risk stratification for cardiac events has been demonstrated. This review bridges basic and clinical research and focuses on applying an understanding of tracer kinetics and neuronal biology, to aid in the interpretation of nuclear imaging of cardiac sympathetic innervation.

Keywords: positron emissions tomography; sympathetic nervous system; sympathetic nervous system radioisotopes.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

3-Iodobenzylguanidine / administration & dosage
Ephedrine / administration & dosage
Ephedrine / analogs & derivatives
Heart / innervation*
Heart Failure / diagnostic imaging*
Heart Failure / physiopathology
Heart Failure / therapy
Humans
Positron-Emission Tomography*
Predictive Value of Tests
Prognosis
Radiopharmaceuticals / administration & dosage
Sympathetic Nervous System / diagnostic imaging*
Tomography, Emission-Computed, Single-Photon*

Substances

Radiopharmaceuticals
3-hydroxyephedrine
3-Iodobenzylguanidine
Ephedrine