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

https://doi.org/10.1016/j.jcmg.2019.01.042Get rights and content
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Highlights

  • SNS dysfunction has been implicated in various cardiac diseases including heart failure, ischemic cardiomyopathy, and sudden cardiac death.

  • Radiotracers for nuclear imaging have been developed to characterize the cardiac SNS.

  • A composite knowledge of neuronal biology, radiotracer kinetics, and the disease pathology is critical to interpret SNS imaging.

  • SNS imaging has clinical application in risk assessment, treatment monitoring, and tailoring treatment strategies across many CVD states.

  • Larger prospective and randomized control trials are required to confirm whether SNS imaging strategies can guide clinical management that can impact outcomes.

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.

Key Words

positron emissions tomography
sympathetic nervous system
sympathetic nervous system radioisotopes

Abbreviations and Acronyms

CAN
cardiac autonomic neuropathy
DM
diabetes mellitus
EPI
epinephrine
HED
hydroxyephedrine
HF
heart failure
H/M
heart-to-mediastinum
ICD
implantable cardioverter-defibrillator
ICM
ischemic cardiomyopathy
LMI1195
N-[3-Bromo-4-(3-[18F]fluoro-propoxy)-benzyl]-guanidine
LV
left ventricular
MAO
monoamino oxidase
MI
myocardial infarction
mIBG
meta-iodobenzylguanidine
NE
norepinephrine
NICM
nonischemic cardiomyopathy
PET
positron emission tomography
SCD
sudden cardiac death
SNS
sympathetic nervous system
SPECT
single-photon emission computed tomography
VMAT2
vesicular monoamine transporter 2

Cited by (0)

This work was supported in part by a grant the Heart and Stroke Foundation of Canada (G-17-0018315). Mr. Zelt is an MD/PhD student supported in part by the Vanier Canada Graduate Scholarship, The University of Ottawa, and by a government/industry grant from the Ontario Research Fund (ORF RE07-021; industry partners Lantheus Medical Imaging and Jubilant DraxImage). Dr. Ahmadi is supported by the University of Ottawa Cardiac Endowment Fund at the University of Ottawa Heart Institute. Dr. Beanlands is a Career Investigator supported by the Heart and Stroke Foundation of Ontario, a Tier 1 Chair in Cardiac Imaging Research at the University of Ottawa; and Vered Chair in Cardiology at the University of Ottawa Heart Institute. Dr. Mielniczuk is a Mid-career Clinician Scientist supported by Heart and Stroke Foundation of Ontario and Tier 2 Chair in HF Research at the University of Ottawa. Dr. deKemp is a consultant for and has received grant funding from Lantheus Medical Imaging and Jubilant DraxImage; and has received revenues from Rubidium-82 generator technology licensed to Jubilant DraxImage and from sales of FlowQuant software. Dr. Beanlands is or has been a consultant for and has received grant funding from GE Healthcare, Lantheus Medical Imaging, and Jubilant DraxImage. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.