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Mishkina AI, Saushkin VV, Atabekov TA, Sazonova SI, Shipulin VV, Massalha S, Batalov RE, Popov SV, Zavadovsky KV. The value of cardiac sympathetic activity and mechanical dyssynchrony as cardiac resynchronization therapy response predictors: comparison between patients with ischemic and non-ischemic heart failure. J Nucl Cardiol 2023; 30:371-382. [PMID: 35834158 DOI: 10.1007/s12350-022-03046-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Impaired cardiac sympathetic activity and mechanical dyssynchrony (MD) are associated with poor prognosis in patients with heart failure (HF) after cardiac resynchronization therapy (CRT). The study aims to assess the significance of scintigraphic evaluation of cardiac sympathetic innervation and contractility in predicting response to CRT in patients with ischemic and non-ischemic chronic HF. METHODS AND RESULTS The study includes 58 HF patients, who were referred for CRT. Prior to CRT all patients underwent 123I-metaiodobenzylguanidine (123I-MIBG) imaging and gated myocardial perfusion imaging (MPI) using a cadmium-zinc-telluride (CZT) SPECT/CT device. At a one-year follow-up post-CRT, the delayed heart-to-mediastinum 123I-MIBG uptake ratio was an independent predictor of CRT response in non-ischemic HF patients (OR 1.469; 95% CI 1.076-2.007, p = .003). In ischemic HF patients the MD index histogram bandwidth (HBW) obtained by CZT-gated MPI had a predictive value (OR 1.06, 95% CI 1.001-1.112, p = .005) to CRT response. CONCLUSION CRT response can be predicted by cardiac 123I-MIBG scintigraphy, specifically by the heart-to-mediastinum ratio in non-ischemic HF and by the MD index HBW in ischemic HF. These results suggest the value of a potentially useful algorithm to improve outcomes in HF patients who are candidates for CRT.
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Affiliation(s)
- Anna I Mishkina
- Department of Nuclear Medicine, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, Russia, 634012
| | - Victor V Saushkin
- Department of Nuclear Medicine, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, Russia, 634012
| | - Tariel A Atabekov
- Department of Interventional Arrhythmology, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russia
| | - Svetlana I Sazonova
- Department of Nuclear Medicine, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, Russia, 634012
| | - Vladimir V Shipulin
- Department of Nuclear Medicine, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, Russia, 634012
| | | | - Roman E Batalov
- Department of Interventional Arrhythmology, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russia
| | - Sergey V Popov
- Department of Interventional Arrhythmology, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russia
| | - Konstantin V Zavadovsky
- Department of Nuclear Medicine, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, Russia, 634012.
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2
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Travin MI. The challenges of using radionuclide imaging to guide cardiac device implantation in patients with heart failure. J Nucl Cardiol 2023; 30:383-387. [PMID: 36053464 DOI: 10.1007/s12350-022-03088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Mark I Travin
- 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, USA.
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3
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Heart diseases (autonomic dysfunctions)—Myocardial innervation imaging: 123I-MIBG planar scintigraphy and SPECT. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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4
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Leite J, Brandão S. Assessment of Cardiac Sympathetic Activity by Nuclear Medicine: Many Clinical Benefits but Weak Recommendation. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20210213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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5
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Verschure DO, Poel E, De Vincentis G, Frantellizzi V, Nakajima K, Gheysens O, de Groot JR, Verberne HJ. The relation between cardiac 123I-mIBG scintigraphy and functional response 1 year after CRT implantation. Eur Heart J Cardiovasc Imaging 2021; 22:49-57. [PMID: 32259839 PMCID: PMC7758029 DOI: 10.1093/ehjci/jeaa045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/21/2020] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Abstract
Aims Cardiac resynchronization therapy (CRT) is a disease-modifying therapy in patients with chronic heart failure (CHF). Current guidelines ascribe CRT eligibility on three parameters only: left ventricular ejection fraction (LVEF), QRS duration, and New York Heart Association (NYHA) functional class. However, one-third of CHF patients does not benefit from CRT. This study evaluated whether 123I-meta-iodobenzylguanidine (123I-mIBG) assessed cardiac sympathetic activity could optimize CRT patient selection. Methods and results A total of 78 stable CHF subjects (age 66.8 ± 9.6 years, 73% male, LVEF 25.2 ± 6.7%, QRS duration 153 ± 23 ms, NYHA 2.2 ± 0.7) referred for CRT implantation were enrolled. Subjects underwent 123I-mIBG scintigraphy prior to implantation. Early and late heart-to-mediastinum (H/M) ratio and 123I-mIBG washout were calculated. CRT response was defined as either an increase of LVEF to >35%, any improvement in LVEF of >10%, QRS shortening to <150 ms, or improvement in NYHA class of >1 class. In 33 patients LVEF increased to >35%, QRS decreased <150 ms in 36 patients, and NYHA class decreased in 33 patients. Late H/M ratio and hypertension were independent predictors of LVEF improvement to >35% (P = 0.0014 and P = 0.0149, respectively). In addition, early H/M ratio, LVEF, and absence of diabetes mellitus (DM) were independent predictors for LVEF improvement by >10%. No independent predictors were found for QRS shortening to <150 ms or improvement in NYHA class. Conclusion Early and late H/M ratio were independent predictors of CRT response when improvement of LVEF was used as measure of response. Therefore, cardiac 123I-mIBG scintigraphy may be used as a tool to optimize selection of subjects that might benefit from CRT.
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Affiliation(s)
- D O Verschure
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.,Department of Cardiology, Zaans Medical Center, Koningin Julianaplein 58, 1502 DV Zaandam, the Netherlands
| | - E Poel
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - G De Vincentis
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - V Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - K Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8640, Japan
| | - O Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Hippokrateslaan 10, 1200 Brussels, Belgium
| | - J R de Groot
- Heart Center, Department of Cardiology, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - H J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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6
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Fukuda K, Hasegawa S, Kawamura T, Waratani N, Hirata K, Higashimori A, Yokoi Y. Changes in cardiac sympathetic nerve activity on 123 I-metaiodobenzylguanidine scintigraphy after MitraClip therapy. ESC Heart Fail 2021; 8:1590-1595. [PMID: 33609015 PMCID: PMC8006686 DOI: 10.1002/ehf2.13266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/23/2021] [Accepted: 02/04/2021] [Indexed: 01/08/2023] Open
Abstract
Aims In patients with heart failure, over‐activation of the cardiac sympathetic nerve (CSN) function is associated with severity of heart failure and worse outcome. The effects of MitraClip therapy on the CSN activity in patients with mitral regurgitation (MR) remained unknown. In this study, we evaluated the impact of the MitraClip therapy on CSN activity assessed by 123I‐metaiodobezylguanidine (MIBG) scintigraphy. Methods and results We enrolled consecutive patients with moderate‐to‐severe (3+) or severe (4+) MR who were scheduled to undergo MitraClip procedure in this prospective observational study. MIBG scintigraphy was performed at baseline and 6 months after the MitraClip procedure to evaluate the heart–mediastinum ratio and washout rate (WR). Changes in these MIBG parameters were analysed. Of the 13 consecutive patients, 10 were successfully treated with MitraClip procedure and completed follow‐up assessment. With regard to the MIBG parameters, changes in the early and delayed heart–mediastinum ratio from baseline to 6 months were not significant (2.16 ± 0.42 to 2.06 ± 0.34, P = 0.38 and 1.87 ± 0.39 to 1.83 ± 0.39, P = 0.43, respectively), whereas WR was significantly decreased (38.6 ± 3.9% to 32.6 ± 3.94%, P = 0.002). Conclusions The CSN activity of the WR on MIBG imaging was improved 6 months after MitraClip therapy in patients with 3+ or 4+ MR.
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Affiliation(s)
- Keisuke Fukuda
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
| | - Seiji Hasegawa
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
| | - Tomonori Kawamura
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
| | - Naoto Waratani
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
| | - Kumiko Hirata
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan.,Department of Medical Science, Osaka Educational University, Osaka, Japan
| | - Akihiro Higashimori
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka, 596-8522, Japan
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7
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Romero-Farina G, Aguadé-Bruix S. Perspective and future direction of intraventricular mechanical dyssynchrony assessment. J Nucl Cardiol 2021; 28:65-71. [PMID: 30684259 DOI: 10.1007/s12350-019-01604-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Guillermo Romero-Farina
- Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Santiago Aguadé-Bruix
- Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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8
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Xiao PL, Cai C, Zhang P, DeSimone CV, Ernst DK, Yin YH, Chen PS, Cha YM. Cardiac resynchronization therapy modulates peripheral sympathetic activity. Heart Rhythm 2020; 17:1139-1146. [DOI: 10.1016/j.hrthm.2020.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/18/2020] [Indexed: 01/06/2023]
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9
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Wan N, Travin MI. Cardiac Imaging With 123I-meta-iodobenzylguanidine and Analogous PET Tracers: Current Status and Future Perspectives. Semin Nucl Med 2020; 50:331-348. [PMID: 32540030 DOI: 10.1053/j.semnuclmed.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Autonomic innervation plays an important role in proper functioning of the cardiovascular system. Altered cardiac sympathetic function is present in a variety of diseases, and can be assessed with radionuclide imaging using sympathetic neurotransmitter analogues. The most studied adrenergic radiotracer is cardiac 123I-meta-iodobenzylguanidine (123I-mIBG). Cardiac 123I-mIBG uptake can be evaluated using both planar and tomographic imaging, thereby providing insight into global and regional sympathetic innervation. Standardly assessed imaging parameters are the heart-to-mediastinum ratio and washout rate, customarily derived from planar images. Focal tracer deficits on tomographic imaging also show prognostic utility, with some data suggesting that the best approach to tomographic image interpretation may differ from conventional methods. Cardiac 123I-mIBG image findings strongly correlate with the severity and prognosis of many cardiovascular diseases, especially heart failure and ventricular arrhythmias. Cardiac 123I-mIBG imaging in heart failure is FDA approved for prognostic purposes. With the robustly demonstrated ability to predict occurrence of potentially fatal arrhythmias, cardiac 123I-mIBG imaging shows promise for better selecting patients who will benefit from an implantable cardioverter defibrillator, but clinical use has been hampered by lack of the randomized trial needed for incorporation into societal guidelines. In patients with ischemic heart disease, cardiac 123I-mIBG imaging aids in assessing the extent of damage and in identifying arrhythmogenic regions. There have also been studies using cardiac 123I-mIBG for other conditions, including patients following heart transplantation, diabetic related cardiac abnormalities and chemotherapy induced cardiotoxicity. Positron emission tomographic adrenergic radiotracers, that improve image quality, have been investigated, especially 11C-meta-hydroxyephedrine, and most recently 18F-fluorbenguan. Cadmium-zinc-telluride cameras also improve image quality. With better spatial resolution and quantification, PET tracers and advanced camera technologies promise to expand the clinical utility of cardiac sympathetic imaging.
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Affiliation(s)
- Ningxin Wan
- Division of Nuclear Medicine, Department of Radiology, and Division of Cardiology, Department of Medicine, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
| | - Mark I Travin
- Division of Nuclear Medicine, Department of Radiology, and Division of Cardiology, Department of Medicine, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY.
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10
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Doytchinova A, Gerson MC. 123I-meta-Iodobenzylguanidine Imaging in Patients with Cardiac Resynchronization Therapy: Results are Intriguing, but Unknowns Remain. J Nucl Cardiol 2020; 27:291-293. [PMID: 30069822 DOI: 10.1007/s12350-018-1381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Anisiia Doytchinova
- Division of Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Myron C Gerson
- Division of Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, OH, USA.
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11
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Mastrocola LE, Amorim BJ, Vitola JV, Brandão SCS, Grossman GB, Lima RDSL, Lopes RW, Chalela WA, Carreira LCTF, Araújo JRND, Mesquita CT, Meneghetti JC. Update of the Brazilian Guideline on Nuclear Cardiology - 2020. Arq Bras Cardiol 2020; 114:325-429. [PMID: 32215507 PMCID: PMC7077582 DOI: 10.36660/abc.20200087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Barbara Juarez Amorim
- Universidade Estadual de Campinas (Unicamp), Campinas, SP - Brazil
- Sociedade Brasileira de Medicina Nuclear (SBMN), São Paulo, SP - Brazil
| | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brazil
- Clínica Cardionuclear, Porto Alegre, RS - Brazil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Fonte Imagem Medicina Diagnóstica, Rio de Janeiro, RJ - Brazil
- Clínica de Diagnóstico por Imagem (CDPI), Grupo DASA, Rio de Janeiro, RJ - Brazil
| | | | - William Azem Chalela
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | | | | | - José Claudio Meneghetti
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
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12
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Moreira RI, Abreu A, Portugal G, Oliveira L, Oliveira M, Rodrigues I, Cruz MC, Cunha PS, Santos V, Clara HS, Carmo MM, Ferreira RC. Prognostic effect and modulation of cardiac sympathetic function in heart failure patients treated with cardiac resynchronization therapy. J Nucl Cardiol 2020; 27:283-290. [PMID: 29992524 DOI: 10.1007/s12350-018-1357-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/11/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cardiac autonomic dysfunction as assessed by 123I-metaiodobenzylguanidine (123I-mIBG) scintigraphy is associated with poor prognosis in heart failure (HF) patients. Although cardiac resynchronization therapy (CRT) has emerged as an effective therapy in improving outcomes on HF patients, its effect on cardiac sympathetic nervous function is still not fully understood. We aimed to study the value of pre-implantation 123I-mIBG late heart-to-mediastinum ratio (HMR) as a predictor of response and outcomes after CRT and to correlate modification in this parameter with CRT response and functional improvement. METHODS AND RESULTS BETTER-HF (Benefit of exercise training therapy and cardiac resynchronization in HF patients) is a prospective randomized clinical trial including HF patients submitted CRT (mean LVEF 24 ± 8%, 74% NYHA class ≥ III) who underwent a clinical, echocardiographic, and scintigraphic assessment before and 6 months after CRT. One-hundred and twenty-one patients were included. Echocardiographic response was observed in 54% and composite outcome of cardiac mortality, cardiac transplant or heart failure hospitalization in 24% of patients. Baseline late HMR was an independent predictor of CRT response (regression coefficient 2.906, 95% CI 0.293-3.903, P .029) and outcomes (HR 0.066 95% CI 0.005-0.880, P .040). At follow-up, 123I-mIBG imaging showed positive changes in cardiac sympathetic nerve activity only in responders to CRT (1.36 ± 0.14 prior vs. 1.42 ± 0.16 after CRT, P .039). There was a significant correlation between improvement in late HMR and improvement in peak oxygen consumption (r 0.547, P < .001). CONCLUSION In our study, baseline cardiac denervation predicted response and clinical outcomes after CRT implantation. Cardiac sympathetic function was improved only in patients who responded to CRT and these positive changes were correlated with improvement in functional capacity.
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Affiliation(s)
- Rita Ilhão Moreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, 1169-024, Lisbon, Portugal.
| | - Ana Abreu
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, 1169-024, Lisbon, Portugal
| | - Guilherme Portugal
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, 1169-024, Lisbon, Portugal
| | - Luís Oliveira
- Nuclear Medicine Department, Medical and Diagnosis Clinic Quadrantes, Lisbon, Portugal
| | - Mário Oliveira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, 1169-024, Lisbon, Portugal
| | - Inês Rodrigues
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, 1169-024, Lisbon, Portugal
| | - Madalena Coutinho Cruz
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, 1169-024, Lisbon, Portugal
| | - Pedro Silva Cunha
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, 1169-024, Lisbon, Portugal
| | - Vanessa Santos
- CIPER, Human Kinetics Faculty, University of Lisbon, Lisbon, Portugal
| | | | - Miguel Mota Carmo
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, 1169-024, Lisbon, Portugal
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Rua de Santa Marta, no. 50, 1169-024, Lisbon, Portugal
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13
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Cruz MC, Abreu A, Portugal G, Santa-Clara H, Cunha PS, Oliveira MM, Santos V, Oliveira L, Rio P, Rodrigues I, Morais LA, Ferreira RC, Carmo MM. Relationship of left ventricular global longitudinal strain with cardiac autonomic denervation as assessed by 123I-mIBG scintigraphy in patients with heart failure with reduced ejection fraction submitted to cardiac resynchronization therapy : Assessment of cardiac autonomic denervation by GLS in patients with heart failure with reduced ejection fraction submitted to CRT. J Nucl Cardiol 2019; 26:869-879. [PMID: 29209951 DOI: 10.1007/s12350-017-1148-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/24/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Heart failure (HF) is associated with cardiac autonomic denervation (AD), which can be non-invasively assessed by 123I-metaiodobenzylguanidine (123I-mIBG) scintigraphy and has prognostic implications. We aimed to study the relationship between myocardial contractility assessed by global longitudinal strain (GLS) and AD assessed by 123I-mIBG scintigraphy in advanced HF. METHODS/RESULTS BETTER-HF is a prospective randomized clinical trial including HF patients (pts) submitted to cardiac resynchronization therapy (CRT) who are submitted to a clinical, echocardiographic, and scintigraphic assessment before and 6 months after CRT. 81 pts were included. An echocardiographic response (absolute increase in left ventricular ejection fraction ≥ 10%) was observed in 73.7% of pts. A higher baseline late heart-to-mediastinum ratio (HMR) was associated with a better echocardiographic response. There was a significant association between late HMR and GLS at baseline and 6 months. At baseline, GLS had an AUC of 0.715 for discrimination for a late HMR < 1.6. A GLS cut-off of - 9% maximized the likelihood of correctly classifying a pt as having severe AD (HMR < 1.6). CONCLUSION Myocardial contractility as assessed by GLS is moderately correlated with AD as assessed by 123I-mIBG scintigraphy and has a good discrimination for the identification of severe cardiac denervation. GLS may allow for a more readily accessible estimation of the degree of AD in advanced HF pts.
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Affiliation(s)
- Madalena Coutinho Cruz
- Serviço de Cardiologia, Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Rua de Santa Marta, 50, 1169-024, Lisbon, Portugal.
| | - Ana Abreu
- Serviço de Cardiologia, Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Rua de Santa Marta, 50, 1169-024, Lisbon, Portugal
| | - Guilherme Portugal
- Serviço de Cardiologia, Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Rua de Santa Marta, 50, 1169-024, Lisbon, Portugal
| | | | - Pedro S Cunha
- Serviço de Cardiologia, Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Rua de Santa Marta, 50, 1169-024, Lisbon, Portugal
| | - Mario M Oliveira
- Serviço de Cardiologia, Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Rua de Santa Marta, 50, 1169-024, Lisbon, Portugal
| | - Vanessa Santos
- CIPER, Human Kinetics Faculty, University of Lisbon, Lisbon, Portugal
| | - Luís Oliveira
- Nuclear Medicine Department, Medical and Diagnosis Clinic Quadrantes, Lisbon, Portugal
| | - Pedro Rio
- Serviço de Cardiologia, Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Rua de Santa Marta, 50, 1169-024, Lisbon, Portugal
| | - Inês Rodrigues
- Serviço de Cardiologia, Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Rua de Santa Marta, 50, 1169-024, Lisbon, Portugal
| | - Luís A Morais
- Serviço de Cardiologia, Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Rua de Santa Marta, 50, 1169-024, Lisbon, Portugal
| | - Rui C Ferreira
- Serviço de Cardiologia, Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Rua de Santa Marta, 50, 1169-024, Lisbon, Portugal
| | - Miguel M Carmo
- Serviço de Cardiologia, Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, EPE, Rua de Santa Marta, 50, 1169-024, Lisbon, Portugal
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal
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Abstract
PURPOSE OF THE REVIEW Cardiorenal syndrome (CRS), defined as concomitant heart and kidney disease, has been a focus of attention for nearly a decade. As more patients survive severe acute and chronic heart and kidney diseases, CRS has emerged as an "epidemic" of modern medicine. Significant advances have been made in unraveling the complex mechanisms that underlie CRS based on classification of the condition into five pathophysiologic subtypes. In types 1 and 2, acute or chronic heart disease results in renal dysfunction, while in types 3 and 4, acute or chronic kidney diseases are the inciting factors for heart disease. Type 5 CRS is defined as concomitant heart and kidney dysfunction as part of a systemic condition such as sepsis or autoimmune disease. RECENT FINDINGS There are ongoing efforts to better define subtypes of CRS based on historical information, clinical manifestations, laboratory data (including biomarkers), and imaging characteristics. Systematic evaluation of CRS by advanced cardiac imaging, however, has been limited in scope and mostly focused on type 4 CRS. This is in part related to lack of clinical trials applying advanced cardiac imaging in the acute setting and exclusion of patients with significant renal disease from studies of such techniques in chronic HF. Advanced cardiac nuclear imaging is well poised for assessment of the pathophysiology of CRS by offering a myriad of molecular probes without the need for nephrotoxic contrast agents. In this review, we examine the current or potential future application of advanced cardiac imaging to evaluation of myocardial perfusion, metabolism, and innervation in patients with CRS.
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Affiliation(s)
- Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Ostrum Street, Bethlehem, PA, 18015, USA.
| | - Srinidhi Meera
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Ostrum Street, Bethlehem, PA, 18015, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, The University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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Boutagy NE, Feher A, Alkhalil I, Umoh N, Sinusas AJ. Molecular Imaging of the Heart. Compr Physiol 2019; 9:477-533. [PMID: 30873600 DOI: 10.1002/cphy.c180007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multimodality cardiovascular imaging is routinely used to assess cardiac function, structure, and physiological parameters to facilitate the diagnosis, characterization, and phenotyping of numerous cardiovascular diseases (CVD), as well as allows for risk stratification and guidance in medical therapy decision-making. Although useful, these imaging strategies are unable to assess the underlying cellular and molecular processes that modulate pathophysiological changes. Over the last decade, there have been great advancements in imaging instrumentation and technology that have been paralleled by breakthroughs in probe development and image analysis. These advancements have been merged with discoveries in cellular/molecular cardiovascular biology to burgeon the field of cardiovascular molecular imaging. Cardiovascular molecular imaging aims to noninvasively detect and characterize underlying disease processes to facilitate early diagnosis, improve prognostication, and guide targeted therapy across the continuum of CVD. The most-widely used approaches for preclinical and clinical molecular imaging include radiotracers that allow for high-sensitivity in vivo detection and quantification of molecular processes with single photon emission computed tomography and positron emission tomography. This review will describe multimodality molecular imaging instrumentation along with established and novel molecular imaging targets and probes. We will highlight how molecular imaging has provided valuable insights in determining the underlying fundamental biology of a wide variety of CVDs, including: myocardial infarction, cardiac arrhythmias, and nonischemic and ischemic heart failure with reduced and preserved ejection fraction. In addition, the potential of molecular imaging to assist in the characterization and risk stratification of systemic diseases, such as amyloidosis and sarcoidosis will be discussed. © 2019 American Physiological Society. Compr Physiol 9:477-533, 2019.
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Affiliation(s)
- Nabil E Boutagy
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Attila Feher
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Imran Alkhalil
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Nsini Umoh
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Albert J Sinusas
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA.,Yale University School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, Connecticut, USA
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Doi T, Nakata T, Yuda S, Hashimoto A. Synergistic prognostic implications of left ventricular mechanical dyssynchrony and impaired cardiac sympathetic nerve activity in heart failure patients with reduced left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2018; 19:74-83. [PMID: 28158459 DOI: 10.1093/ehjci/jew334] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/26/2016] [Indexed: 11/12/2022] Open
Abstract
Aims Impairment of cardiac sympathetic innervation is a potent prognostic marker in heart failure, while left ventricular mechanical dyssynchrony (LVMD) has recently been noted as a novel prognosis determinant in heart failure patients with reduced LV ejection fraction (HFrEF). This study was designed to determine the correlation between cardiac sympathetic innervation quantified by metaiodobenzylguanidine (MIBG) activity and LVMD measured by electrocardiogram-gated myocardial perfusion imaging and to evaluate their incremental prognostic values in HFrEF patients. Methods and results A total of 570 consecutive HFrEF patients were followed up for 19.6 months with a primary endpoint of lethal cardiac events (CE) such as sudden cardiac death, death due to pump failure and appropriate ICD shock against life-threatening ventricular tachyarrhythmias. Cardiac sympathetic function and innervation were quantified as heart-to-mediastinum ratio (HMR) and washout kinetics of cardiac MIBG activity. LVMD was assessed by a standard deviation (SD) of systolic phase angle in gated myocardial perfusion imaging. Patients with CE (n = 166, 29%) had a significantly lower HMR and a significantly greater phase SD than did non-CE patients: 1.46 ± 0.28 vs. 1.63 ± 0.29, P < 0.0001 and 39.1 ± 11.6 vs. 33.1 ± 10.1, P < 0.0001, respectively. Compared to the single use of optimal cut-offs of late HMR (1.54) and phase SD (38), their combination more precisely discriminated high-risk or low-risk patients from others with log rank values from 7.78 to 65.2 (P = 0.0053 to P ≤ 0.0001). Among significant univariate variables, multivariate Cox proportional hazards model identified NYHA functional class, estimated glomerular filtration rate (eGFR), HMR 1.54 and phase SD 60 as significant determinants of CE with hazard ratios of 3.108 (95% CI, 2.472-3.910; P < 0.0001), 0.988 (95% CI, 0.981-0.996; P = 0.0021), 0.257 (95% CI, 0.128-0.498; P < 0.0001) and 1.019 (95% CI, 1.019-1.037; P = 0.0228), respectively. By combining the four independent determinants, the prognostic powers synergistically (P < 0.0001) increased maximally to 263.8. Conclusions Left ventricular mechanical dyssynchrony and impairment of cardiac sympathetic innervation are synergistically related to lethal cardiac events, contributing to better stratification of lethal cardiac event-risks and probably to optimization of therapeutic strategy in patients with HFrEF.
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Affiliation(s)
- Takahiro Doi
- Department of Cardiology, Obihiro-Kosei General Hospital, W6-S8-1, Obihiro, Hokkaido, 81-080-0016, Japan
| | - Tomoaki Nakata
- Department of Cardiology, Hakodate Goryokaku Hospital, Goryokaku cho 38-3, Hakodate, Hokkaido, 81-040-8611, Japan
| | - Satoshi Yuda
- Department of Cardiology, Renal and Metabolic Medicine, Sapporo Medical University, Chuo-ku S1-W16-291, Sapporo, Hokkaido, 81-060-8543, Japan
| | - Akiyoshi Hashimoto
- Department of Cardiology, Renal and Metabolic Medicine, Sapporo Medical University, Chuo-ku S1-W16-291, Sapporo, Hokkaido, 81-060-8543, Japan
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Werner RA, Chen X, Hirano M, Rowe SP, Lapa C, Javadi MS, Higuchi T. SPECT vs. PET in cardiac innervation imaging: clash of the titans. Clin Transl Imaging 2018; 6:293-303. [PMID: 30148120 PMCID: PMC6096538 DOI: 10.1007/s40336-018-0289-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE We aim to provide an overview of the conventional single photon emission computed tomography (SPECT) and emerging positron emission tomography (PET) catecholamine analogue tracers for assessing myocardial nerve integrity, in particular focusing on 18F-labeled tracers. RESULTS Increasingly, the cardiac sympathetic nervous system (SNS) is being studied by non-invasive molecular imaging approaches. Forming the backbone of myocardial SNS imaging, the norepinephrine (NE) transporter at the sympathetic nerve terminal plays a crucial role for visualizing denervated myocardium: in particular, the single-photon-emitting NE analogue 123I-meta-Iodobenzylguanidine (123I-mIBG) has demonstrated favorable results in the identification of patients at a high risk for cardiac death. However, cardiac neuronal PET agents offer several advantages including improved spatio-temporal resolution and intrinsic quantifiability. Compared to their 11C-labeled counterparts with a short half-life (20.4 min), novel 18F-labeled PET imaging agents to assess myocardial nerve integrity have the potential to revolutionize the field of SNS molecular imaging. The longer half-life of 18F (109.8 min) allows for more flexibility in the study design and delivery from central cyclotron facilities to smaller hospitals may lead to further cost reduction. A great deal of progress has been made by the first in-human studies of such 18F-labeled SNS imaging agents. Moreover, dedicated animal platforms open avenues for further insights into the handling of radiolabeled catecholamine analogues at the sympathetic nerve terminal. CONCLUSIONS 18F-labeled imaging agents demonstrate key properties for mapping cardiac sympathetic nerve integrity and might outperform current SPECT-based or 11C-labeled tracers in the long run.
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Affiliation(s)
- Rudolf A. Werner
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Nuclear Medicine, University of Wuerzburg, Oberduerrbacher Strasse 6, 97080 Würzburg, Germany
- Comprehensive Heart Failure Center, University of Wuerzburg, Würzburg, Germany
| | - Xinyu Chen
- Department of Nuclear Medicine, University of Wuerzburg, Oberduerrbacher Strasse 6, 97080 Würzburg, Germany
- Comprehensive Heart Failure Center, University of Wuerzburg, Würzburg, Germany
| | - Mitsuru Hirano
- Department of Biomedical Imaging, National Cardiovascular and Cerebral Center, Suita, Japan
| | - Steven P. Rowe
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Constantin Lapa
- Department of Nuclear Medicine, University of Wuerzburg, Oberduerrbacher Strasse 6, 97080 Würzburg, Germany
| | - Mehrbod S. Javadi
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University of Wuerzburg, Oberduerrbacher Strasse 6, 97080 Würzburg, Germany
- Comprehensive Heart Failure Center, University of Wuerzburg, Würzburg, Germany
- Department of Biomedical Imaging, National Cardiovascular and Cerebral Center, Suita, Japan
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18
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Abstract
PURPOSE OF REVIEW Autonomic innervation is crucial for regulating cardiac function. Sympathetic innervation imaging with 123I-mIBG and analogous PET tracers assesses disease in ways that differ from customary methods. This review describes practical use in various clinical scenarios, discusses recent guidelines, presents new data confirming risk stratification power, describes an ongoing prospective study, and looks forward to wider use in patient management. RECENT FINDINGS ASNC 123I-mIBG guidelines are available, expanding on European guidelines. ADMIRE-HF patient follow-up increased to 2 years in ADMIRE HFX, demonstrating independent mortality risk reclassification. ADMIRE-HF findings were substantiated in a Japanese consortium study and in the PAREPET 11C-HED PET study. Exciting potential uses of adrenergic imaging are management of LVADs and VT ablation. CZT cameras provide advantages, but derived parameters differ from Anger camera values. Independent risk stratification utility of adrenergic imaging with 123I-mIBG and PET tracers is continuously being confirmed. An ongoing prospective randomized study promises to establish patient management utility. There is potential for wider use and improved images with newer cameras and PET.
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Affiliation(s)
- Mark I Travin
- Department of Radiology/Division of Nuclear Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East-210th Street, Bronx, NY, 10467-2490, USA.
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Shirani J, Singh A, Agrawal S, Dilsizian V. Cardiac molecular imaging to track left ventricular remodeling in heart failure. J Nucl Cardiol 2017; 24:574-590. [PMID: 27480973 DOI: 10.1007/s12350-016-0620-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 07/13/2016] [Indexed: 12/11/2022]
Abstract
Cardiac left ventricular (LV) remodeling is the final common pathway of most primary cardiovascular diseases that manifest clinically as heart failure (HF). The more advanced the systolic HF and LV dysfunction, the worse the prognosis. The knowledge of the molecular, cellular, and neurohormonal mechanisms that lead to myocardial dysfunction and symptomatic HF has expanded rapidly and has allowed sophisticated approaches to understanding and management of the disease. New therapeutic targets for pharmacologic intervention in HF have also been identified through discovery of novel cellular and molecular components of membrane-bound receptor-mediated intracellular signal transduction cascades. Despite all advances, however, the prognosis of systolic HF has remained poor in general. This is, at least in part, related to the (1) relatively late institution of treatment due to reliance on gross functional and structural abnormalities that define the "heart failure phenotype" clinically; (2) remarkable genetic-based interindividual variations in the contribution of each of the many molecular components of cardiac remodeling; and (3) inability to monitor the activity of individual pathways to cardiac remodeling in order to estimate the potential benefits of pharmacologic agents, monitor the need for dose titration, and minimize side effects. Imaging of the recognized ultrastructural components of cardiac remodeling can allow redefinition of heart failure based on its "molecular phenotype," and provide a guide to implementation of "personalized" and "evidence-based" evaluation, treatment, and longitudinal monitoring of the disease beyond what is currently available through randomized controlled clinical trials.
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Affiliation(s)
- Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, USA.
| | - Amitoj Singh
- Department of Cardiology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, USA
| | - Sahil Agrawal
- Department of Cardiology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Berukstis A, Vajauskas D, Gargalskaite U, Misonis N, Burneikaite G, Zakarkaite D, Miglinas M, Laucevicius A. Impact of renal sympathetic denervation on cardiac sympathetic nerve activity evaluated by cardiac MIBG imaging. EUROINTERVENTION 2017; 11:1070-6. [PMID: 26788709 DOI: 10.4244/eijv11i9a215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The objective of the present study was to investigate an effect of renal artery sympathetic denervation (RASD) on patients with resistant hypertension and RASD effect on cardiac sympathetic nerve activity. It is known that an abnormally activated sympathetic tone is associated with progression of heart failure (HF). METHODS AND RESULTS We investigated 16 patients with resistant arterial hypertension (mean age 54.88±7.89 years, mean 24-hr ambulatory blood pressure [BP] systolic 161.07±20.12 mmHg, diastolic 97.6±16.25 mmHg, using 6.44±0.96 antihypertensive drugs), who underwent bilateral RASD. Echocardiography, 24-hr ambulatory BP and 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy were performed before and six months after RASD. There were no significant changes in 24-hr ambulatory systolic and diastolic BP before RASD and six months after it: systolic BP before RASD was 161.07±20.12 mmHg and 144.93±17.27 mmHg after (p=0.050); diastolic BP before RASD was 97.6±16.25 mmHg and 89.87±12.33 mmHg after (p=0.182). We observed a significant change in cardiac sympathetic nerve activity assessed by 123I-MIBG scintigraphy, as an increase of late heart-to-mediastinum (H/M) ratio, varying from 2.21±0.47 to 2.35±0.52 m/s (p=0.02). CONCLUSIONS Selective RASD significantly reduces cardiac sympathetic overdrive assessed by 123I-MIBG scintigraphy. Presumably, this positively affects HF progression in patients with resistant arterial hypertension.
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Affiliation(s)
- Andrius Berukstis
- Center of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania
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21
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Giubbini R, Milan E, Marcassa C, Paghera B, Fracassi F, Camoni L, Rodella C, Bertagna F, Motta F, Bertoli M, Campini R. 1-23I-MIBG thyroid uptake: Implications for MIBG imaging of the heart. J Nucl Cardiol 2016; 23:1335-1339. [PMID: 25963285 DOI: 10.1007/s12350-015-0142-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 04/04/2015] [Accepted: 04/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND 123I-MIBG has been widely used in patients with heart failure and neurological disorders. The patients are pre-treated with Lugol's oral solution or potassium perchlorate to prevent thyroid uptake of unlabeled 123I to limit the thyroid radiation exposure. However, despite the inhibition of the iodide pump, the thyroid is frequently visualized. The aim of this study was to study the pattern of thyroid uptake. METHODS We reviewed the 123I-MIBG images of 57 patients studied in three different centers in Italy for cardiac (n = 42) or neurological (n = 15) indications. They were imaged at 15 minutes and 4 hours after injection and in all patients, the thyroid was included in the imaging field of view. In 2 of the 3 centers, the patients were pre-treated with Lugol's oral solution and/or potassium perchlorate (group 1) but in the third center, they were not (group 2). The following imaging parameters were evaluated: heart-to-mediastinum ratio (H/M), thyroid-to-mediastinum ratio (T/M) at 4 hours, and tracer wash out from the heart (HWO) and from the thyroid (TWO). RESULTS In the cardiac patients, the HWO was 22.98 ± 7.16% and TWO was 11.4 ± 11.86% (P < .0001). The TWO was 12.2 ± 13.1% in group 1 and 10.05 ± 8.97% in group 2 (P = NS). In the neurological patients the HWO was 26 ± 8.1% and the TWO was 20.32 ± 6.41 (P < .05). The difference in TWO was statistically significant (P < .01) between cardiac and neurological patients, whereas the HWO was not. The 4-hour H/M was 1.49 ± 0.23 in cardiac patients vs 1.4 ± 0.39 in neurological patients (P = NS). The 4-hour T/M was 1.33 ± 0.3 in cardiac patients vs 1.15 ± 0.13 in neurological patients (P < 0.05). CONCLUSION The thyroid visualization in MIBG imaging is likely an expression of thyroid sympathetic innervation. The differences in TWO and T/M ratio in cardiac and neurological patients probably express differences in thyroid dopaminergic receptors. Thus, pre-treatment with potassium perchlorate or Lugol's solution may not be justified in patients undergoing 123I-MIBG imaging in whom the risk of side effects due to pre-treatment could be higher than the risk due to thyroid radiation exposure.
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Affiliation(s)
- Raffaele Giubbini
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy.
| | - Elisa Milan
- Nuclear Medicine Unit, San Giacomo Apostolo Hospital, Castelfranco Veneto, TV, Italy
| | - Claudio Marcassa
- Cardiology Department, Fondazione Maugeri Centro Medico, Veruno, NO, Italy
| | - Barbara Paghera
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Federica Fracassi
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Luca Camoni
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Carlo Rodella
- Health Physics Department, Spedali Civili, Brescia, Italy
| | - Francesco Bertagna
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Federica Motta
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Mattia Bertoli
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Riccardo Campini
- Nuclear Medicine Unit, Fondazione Maugeri Centro Medico, Veruno, NO, Italy
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23
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Nakajima K, Nakata T, Matsuo S, Jacobson AF. Creation of mortality risk charts using 123I meta-iodobenzylguanidine heart-to-mediastinum ratio in patients with heart failure: 2- and 5-year risk models. Eur Heart J Cardiovasc Imaging 2015; 17:1138-45. [PMID: 26705487 PMCID: PMC5031228 DOI: 10.1093/ehjci/jev322] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/13/2014] [Indexed: 01/08/2023] Open
Abstract
Aims 123I meta-iodobenzylguanidine (MIBG) imaging has been extensively used for prognostication in patients with chronic heart failure (CHF). The purpose of this study was to create mortality risk charts for short-term (2 years) and long-term (5 years) prediction of cardiac mortality. Methods and results Using a pooled database of 1322 CHF patients, multivariate analysis, including 123I-MIBG late heart-to-mediastinum ratio (HMR), left ventricular ejection fraction (LVEF), and clinical factors, was performed to determine optimal variables for the prediction of 2- and 5-year mortality risk using subsets of the patients (n = 1280 and 933, respectively). Multivariate logistic regression analysis was performed to create risk charts. Cardiac mortality was 10 and 22% for the sub-population of 2- and 5-year analyses. A four-parameter multivariate logistic regression model including age, New York Heart Association (NYHA) functional class, LVEF, and HMR was used. Annualized mortality rate was <1% in patients with NYHA Class I–II and HMR ≥ 2.0, irrespective of age and LVEF. In patients with NYHA Class III–IV, mortality rate was 4–6 times higher for HMR < 1.40 compared with HMR ≥ 2.0 in all LVEF classes. Among the subset of patients with b-type natriuretic peptide (BNP) results (n = 491 and 359 for 2- and 5-year models, respectively), the 5-year model showed incremental value of HMR in addition to BNP. Conclusion Both 2- and 5-year risk prediction models with 123I-MIBG HMR can be used to identify low-risk as well as high-risk patients, which can be effective for further risk stratification of CHF patients even when BNP is available.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | | | - Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Japan
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Gupta S, Amanullah A. Radionuclide imaging of cardiac sympathetic innervation in heart failure: unlocking untapped potential. Heart Fail Rev 2015; 20:215-26. [PMID: 25135163 DOI: 10.1007/s10741-014-9456-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Heart failure (HF) is associated with sympathetic overactivity, which contributes to disease progression and arrhythmia development. Cardiac sympathetic innervation imaging can be performed using radiotracers that are taken up in the presynaptic nerve terminal of sympathetic nerves. The commonly used radiotracers are (123)I-metaiodobenzylguanidine ((123)I-mIBG) for planar and single-photon emission computed tomography imaging, and (11)C-hydroxyephedrine for positron emission tomography imaging. Sympathetic innervation imaging has been used in assessing prognosis, response to treatment, risk of ventricular arrhythmias and sudden death and prediction of response to cardiac resynchronization therapy in patients with HF. Other potential applications of these techniques are in patients with chemotherapy-induced cardiomyopathy, predicting myocardial recovery in patients with left ventricular assist devices, and assessing reinnervation following cardiac transplantation. There is a lack of standardization with respect to technique of (123)I-mIBG imaging that needs to be overcome for the imaging modality to gain popularity in clinical practice.
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Affiliation(s)
- Shuchita Gupta
- Einstein Institute for Heart and Vascular Health, Einstein Medical Center, 5501 Old York Road, 3rd Floor Levy Building, Philadelphia, PA, 19141, USA,
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Nakajima K, Nakata T. Cardiac 123I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan. J Nucl Med 2015; 56 Suppl 4:11S-19S. [PMID: 26033897 DOI: 10.2967/jnumed.114.142794] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cardiac neuroimaging with (123)I-metaiodobenzylguanidine ((123)I-MIBG) has been officially used in clinical practice in Japan since 1992. The nuclear cardiology guidelines of the Japanese Circulation Society, revised in 2010, recommended cardiac (123)I-MIBG imaging for the management of heart failure (HF) patients, particularly for the assessment of HF severity and prognosis of HF patients. Consensus in North American and European countries regarding incorporation into clinical practice, however, has not been established yet. This article summarizes 22 y of clinical applications in Japan of (123)I-MIBG imaging in the field of cardiology; these applications are reflected in cardiology guidelines, including recent methodologic advances. A standardized cardiac (123)I-MIBG parameter, the heart-to-mediastinum ratio (HMR), is the basis for clinical decision making and enables common use of parameters beyond differences in institutions and studies. Several clinical studies unanimously demonstrated its potent independent roles in prognosis evaluation and risk stratification irrespective of HF etiologies. An HMR of less than 1.6-1.8 and an accelerated washout rate are recognized as high-risk indicators of pump failure death, sudden cardiac death, and fatal arrhythmias and have independent and incremental prognostic values together with known clinical variables, such as left ventricular ejection fraction and brain natriuretic peptide. Another possible use of this imaging technique is the selection of therapeutic strategy, such as pharmacologic treatment and nonpharmacologic treatment with an implantable cardioverter-defibrillator or cardiac resynchronization device; however, this possibility remains to be investigated. Recent multiple-cohort database analyses definitively demonstrated that patients who were at low risk for lethal events and who were defined by an HMR of greater than 2.0 on (123)I-MIBG studies had a good long-term prognosis. Future investigations of cardiac (123)I-MIBG imaging will contribute to better risk stratification of low-risk and high-risk populations, to the establishment of cost-effective use of this imaging technique for the management of HF patients, and to worldwide acceptance of this imaging technique in clinical cardiology practice.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan; and
| | - Tomoaki Nakata
- Cardiology Department, Hakodate Goryoukaku Hospital, Hakodate, Japan
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Abstract
Cardiac autonomic innervation plays an important role in regulating function. Adrenergic innervation imaging is possible with the norepinephrine analogue radiotracer iodine 123 meta-iodobenzylguanidine ((123)I-mIBG) and positron emitting tracers such carbon-11 hydroxyephedrine. (123)I-mIBG uptake is assessed globally via the heart to mediastinum ratio on planar images and regionally with tomographic imaging and has utility in various cardiac diseases. There is promise for guiding expensive invasive therapies such as implantable defibrillators, ventricular assist devices, and transplant. There are reports of utility in primary arrhythmic conditions, ischemic heart disease, and diabetes and after cardiac damaging chemotherapy.
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Affiliation(s)
- Mark I Travin
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, 111 East-210th Street, Bronx, NY 10467-2490, USA.
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Martignani C, Diemberger I, Nanni C, Biffi M, Ziacchi M, Boschi S, Corzani A, Fanti S, Sambuceti G, Boriani G. Cardiac resynchronization therapy and cardiac sympathetic function. Eur J Clin Invest 2015; 45:792-9. [PMID: 26036750 DOI: 10.1111/eci.12471] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/29/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an established therapy for advanced congestive heart failure, improving both survival and hospitalization. The mechanism beneath these improvements still needs to be defined as about one-third of the patients do not benefit from resynchronization. Restoration of sympatho-vagal function can play a significant role in the process, but available data are limited. In this scenario, positron emission tomography scans with (11) C-hydroxyephedrine, a noradrenaline analogous, has the potential to characterize the modifications of the sympathetic nervous system induced by CRT in decompensated patients. MATERIALS AND METHODS Ten patients (six males, age 68 ± 10 years) with primary dilated cardiomyopathy were studied before and after resynchronization (acutely and after 3 months), from a clinical and echocardiographic point of view. Their cardiac sympathetic nerve activity was evaluated by (11) C-hydroxyephedrine positron emission tomography before resynchronization, at short and medium term after resynchronization. RESULTS Responders to CRT (patients showing ≥ 15% decrease in left ventricular end-systolic volume) showed a higher level of left ventricular radiotracer uptake both at baseline and after resynchronization with respect to nonresponders. This was coupled with a progressive improvement in homogeneity in left ventricular tracer uptake mainly in responders. CONCLUSIONS Cardiac resynchronization therapy improves cardiac sympathetic nerve activity in responders since its activation, while nonresponders do not show any significant change at any time of evaluation. CRT seems to be more effective in those patients with a still structurally preserved, yet functionally impaired, neuroautonomic system.
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Affiliation(s)
- Cristian Martignani
- Institute of Cardiology, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Igor Diemberger
- Institute of Cardiology, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Cristina Nanni
- Department of Nuclear Medicine, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Mauro Biffi
- Institute of Cardiology, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Stefano Boschi
- Department of Nuclear Medicine, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Alessandro Corzani
- Institute of Cardiology, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Department of Nuclear Medicine, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Gianmario Sambuceti
- Department of Health Science, Nuclear Medicine, IRCCS AOU San Martino - IST, University of Genoa, Genoa, Italy
| | - Giuseppe Boriani
- Institute of Cardiology, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
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Capitanio S, Nanni C, Marini C, Bonfiglioli R, Martignani C, Dib B, Fuccio C, Boriani G, Picori L, Boschi S, Morbelli S, Fanti S, Sambuceti G. Heterogeneous response of cardiac sympathetic function to cardiac resynchronization therapy in heart failure documented by 11[C]-hydroxy-ephedrine and PET/CT. Nucl Med Biol 2015; 42:858-63. [PMID: 26239084 DOI: 10.1016/j.nucmedbio.2015.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/30/2015] [Accepted: 07/05/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) is an accepted treatment in patients with end-stage heart failure. PET permits the absolute quantification of global and regional homogeneity in cardiac sympathetic innervation. We evaluated the variation of cardiac adrenergic activity in patients with idiopathic heart failure (IHF) disease (NYHA III-IV) after CRT using (11)C-hydroxyephedrine (HED) PET/CT. METHODS Ten IHF patients (mean age = 68; range = 55-81; average left ventricular ejection fraction 26 ± 4%) implanted with a resynchronization device underwent three HED PET/CT studies: PET 1 one week after inactive device implantation; PET 2, one week after PET 1 under stimulated rhythm; PET 3, at 3 months under active CRT. A dedicated software (PMOD 3.4 version) was used to estimate global and regional cardiac uptake of HED through 17 segment polar maps. RESULTS At baseline, HED uptake was heterogeneously distributed throughout the left ventricle with a variation coefficient of 18 ± 5%. This variable markedly decreased after three months CRT (12 ± 5%, p < 0.01). Interestingly, subdividing the 170 myocardial segments (17 segments of each patient multiplied by the number of patients) into two groups, according to the median value of tracer uptake expressed as % of maximal myocardial uptake (76%), we observed a different behaviour depending on baseline innervation: HED uptake significantly increased only in segments with "impaired innervation" (SUV 2.61 ± 0.92 at PET1 and 3.05 ± 1.67 at three months, p < 0.01). CONCLUSION As shown by HED PET/CT uptake and distribution, improvement in homogeneity of myocardial neuronal function reflected a selective improvement of tracer uptake in regions with more severe neuronal damage. ADVANCES IN KNOWLEDGE These finding supported the presence of a myocardial regional variability in response of cardiac sympathetic system to CRT and a systemic response involving remote tissues with rich adrenergic innervation. IMPLICATION FOR PATIENT CARE This work might contribute to identify imaging parameters that could predict the response to CRT therapy.
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Affiliation(s)
- Selene Capitanio
- Nuclear Medicine, IRCCS AOU San Martino-IST, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Cristina Nanni
- Nuclear Medicine, Hematology-Oncology and Laboratory Medicine Department, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant' Orsola-Malpighi, University of Bologna, Italy
| | - Cecilia Marini
- CNR Institute of Bioimages and Molecular Physiology, Milan, Section of Genoa, Italy
| | - Rachele Bonfiglioli
- Nuclear Medicine, Hematology-Oncology and Laboratory Medicine Department, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant' Orsola-Malpighi, University of Bologna, Italy
| | - Cristian Martignani
- Istitute of Cardiology, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant' Orsola-Malpighi, University of Bologna, Italy
| | - Bassam Dib
- Nuclear Medicine, IRCCS AOU San Martino-IST, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Chiara Fuccio
- Nuclear Medicine, Hematology-Oncology and Laboratory Medicine Department, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant' Orsola-Malpighi, University of Bologna, Italy
| | - Giuseppe Boriani
- Istitute of Cardiology, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant' Orsola-Malpighi, University of Bologna, Italy
| | - Lorena Picori
- Nuclear Medicine, IRCCS AOU San Martino-IST, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Stefano Boschi
- Nuclear Medicine, Hematology-Oncology and Laboratory Medicine Department, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant' Orsola-Malpighi, University of Bologna, Italy
| | - Silvia Morbelli
- Nuclear Medicine, IRCCS AOU San Martino-IST, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Stefano Fanti
- Nuclear Medicine, Hematology-Oncology and Laboratory Medicine Department, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant' Orsola-Malpighi, University of Bologna, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine, IRCCS AOU San Martino-IST, Department of Health Sciences, University of Genoa, Genoa, Italy.
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Scholtens AM, Braat AJAT, Tuinenburg A, Meine M, Verberne HJ. Cardiac sympathetic innervation and cardiac resynchronization therapy. Heart Fail Rev 2015; 19:567-73. [PMID: 23749044 DOI: 10.1007/s10741-013-9400-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cardiac resynchronization therapy (CRT) is a disease modifying, device-driven treatment that can reduce morbidity and mortality in patients with heart failure. According to the current guidelines, the indication for CRT is only based on QRS duration and functional class of heart failure. However, a substantial amount of patients do not respond to therapy. In addition, CRT is accompanied by significant cost and potential morbidity. It is therefore vital to improve patient selection for CRT to improve patient outcome and minimize therapy-related complications. In this regard, cardiac sympathetic innervation may be of interest. This review addresses the currently available literature, 9 studies with a total number of 225 patients, on CRT and cardiac innervation scintigraphy with (123)I-metaiodobenzylguanidine.
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Affiliation(s)
- A M Scholtens
- Department of Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands,
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Application of Cardiac Neurohormonal Imaging to Heart Failure, Transplantation, and Diabetes. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9323-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Relationship between quantitative cardiac neuronal imaging with 123I-meta-iodobenzylguanidine and hospitalization in patients with heart failure. Eur J Nucl Med Mol Imaging 2014; 41:1666-72. [DOI: 10.1007/s00259-014-2819-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 05/19/2014] [Indexed: 01/08/2023]
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Boogers MM, Chen J, Bax JJ. Role of nuclear imaging in cardiac resynchronization therapy. Expert Rev Cardiovasc Ther 2014; 7:65-72. [DOI: 10.1586/14779072.7.1.65] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Pulmonary vein isolation in patients with paroxysmal atrial fibrillation is associated with regional cardiac sympathetic denervation. EJNMMI Res 2013; 3:81. [PMID: 24360192 PMCID: PMC3892075 DOI: 10.1186/2191-219x-3-81] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Circumferential pulmonary vein isolation (PVI) is the cornerstone of the current state-of-the-art management of atrial fibrillation (AF). However, the precise mechanisms behind AF relapses post PVI are still unknown. Since the activity of the autonomous nervous system is crucial in triggering paroxysmal AF, we hypothesized that PVI is associated with changes of cardiac sympathetic activity. METHODS Sixteen patients with paroxysmal AF underwent cardiac iodine-123-meta-iodobenzylguanidine (123I-mIBG) planar cardiac imaging and single-photon emission computed tomography with low-dose computed tomography (SPECT/CT) for attenuation correction before and 4 weeks after PVI. The heart-to-mediastinum ratio (H/M ratio), washout rate (WR), regional myocardial uptake, and regional washout were analyzed. RESULTS The late H/M ratio was unchanged by PVI (pre, 2.9 ± 0.5 vs. post, 2.7 ± 0.6, p = 0.53). Four of the 16 patients (25%) displayed regional deficits before PVI. After PVI, regional deficits were present in ten patients (62.5%) with newly emerging deficits localized in the inferolateral wall. In a 6-month follow-up, four out of the ten patients (40%) with regional 123I-mIBG defects suffered from a recurrence of AF, while only one of the six patients (16.7%) without a regional 123I-mIBG defect experienced a recurrence. CONCLUSION A significant number of patients with paroxysmal AF show regional cardiac sympathetic innervation deficits at baseline. In addition, PVI is associated with newly emerging defects. The presence of regional sympathetic denervation after PVI may correlate with the risk of AF relapses.
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Klein T, Dilsizian V, Cao Q, Chen W, Dickfeld TM. The potential role of iodine-123 metaiodobenzylguanidine imaging for identifying sustained ventricular tachycardia in patients with cardiomyopathy. Curr Cardiol Rep 2013; 15:359. [PMID: 23536110 PMCID: PMC3631517 DOI: 10.1007/s11886-013-0359-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Implantable cardioverter-defibrillators (ICDs) significantly reduce mortality in patients with depressed left ventricular ejection fraction (LVEF) and heart failure (HF). However, shortcomings of LVEF to accurately identify those at greatest risk of ventricular tachyarrhythmias have led to the pursuit of alternative means to refine qualification criteria for ICD implantation. It is well established that imaging the cardiac nervous system with123I meta-iodobenzylguanidine (123I-mIBG) provides incremental prognostic value in patients with HF beyond LVEF. Whether 123I-mIBG will also play an important role for identifying and/or predicting sustained ventricular tachyarrhythmias in patients with cardiomyopathy and determining those who may benefit from ICD implantation is currently under investigation. Novel imaging approaches that pinpoint the site of ventricular arrhythmias and guide ventricular tachycardia ablation are presented.
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Affiliation(s)
- Thomas Klein
- Maryland Arrhythmia and Cardiology Imaging Group (MACIG), Department of Medicine, Division of Cardiology, University of Maryland Medical Center, 22 South Greene St, Baltimore, MD, 21201, USA
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Yonezawa M, Nagao M, Abe K, Matsuo Y, Baba S, Kamitani T, Isoda T, Maruoka Y, Jinnouchi M, Yamasaki Y, Abe K, Higo T, Yoshiura T, Honda H. Relationship between impaired cardiac sympathetic activity and spatial dyssynchrony in patients with non-ischemic heart failure: assessment by MIBG scintigraphy and tagged MRI. J Nucl Cardiol 2013; 20:600-8. [PMID: 23653269 DOI: 10.1007/s12350-013-9715-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 03/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Impairment of cardiac sympathetic activity has various detrimental effects on cardiac function. The purpose was to investigate the relationship between left ventricular (LV) dyssynchrony and cardiac sympathetic activity in non-ischemic heart failure (HF). METHODS Twenty-seven patients with non-ischemic HF were enrolled. Cardiac sympathetic activity was assessed by heart-to-mediastinum ratio (H/M ratio) on (123)I-Metaiodobenzylguanidine scintigraphy. LV dyssynchrony was assessed by cross-correlation analysis of time curves of myocardial circumferential strains delivered from cine-tagging MR images. Temporal dyssynchrony was defined as contraction delay between septal and lateral segments >110 milliseconds. Spatial dyssynchrony was defined as the negative value of the maximum correlation for the two strain time curves. RESULTS H/M ratio was significantly lower for patients with spatial dyssynchrony compared to patients without (1.8 ± 0.3 vs 2.1 ± 0.3, P < .05). There was no difference between patients with and without temporal dyssynchrony (2.0 ± 0.2 vs 2.0 ± 0.3). The incidence of spatial dyssynchrony was significantly higher in patients with H/M ratio <2.0 than those whose ratios were ≥2.0 (75% vs 20%, P = .001). There was no difference in the incidence of temporal dyssynchrony between the two groups (17% vs 20%). CONCLUSION Impairment of cardiac sympathetic activity was found to be associated with spatial dyssynchrony in patients with non-ischemic HF.
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Affiliation(s)
- Masato Yonezawa
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Flotats A. Advances in Molecular Imaging: Innervation Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9209-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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37
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George RS, Birks EJ, Cheetham A, Webb C, Smolenski RT, Khaghani A, Yacoub MH, Kelion A. The effect of long-term left ventricular assist device support on myocardial sympathetic activity in patients with non-ischaemic dilated cardiomyopathy. Eur J Heart Fail 2013; 15:1035-43. [PMID: 23610136 DOI: 10.1093/eurjhf/hft059] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Dilated cardiomyopathy (DCM) patients have abundant levels of norepinephrine secondary to failure of the norepinephrine transporter uptake mechanism. Little is known about the effects of an LV assist device (LVAD) on cardiac sympathetic innervations and norepinephrine transporter dysfunction. This study examines the effects of continuous-flow HeartMate II LVAD on cardiac sympathetic innervations using [(123)I]metaiodobenzylguanidine ([(123)I]MIBG) nuclear imaging. METHODS AND RESULTS After injecting 431 ± 21 MBq of [(123)I]MIBG, planar scintigraphy was performed at 15 min and 4 h in 14 consecutive non-diabetic non-ischaemic DCM patients. Scans were executed early post-LVAD implantation (T1) and prior to either device explantation for myocardial recovery or transplant listing (T2). [(123)I]MIBG measured parameters included early and delayed heart-mediastinum (H/M) ratios and washout rate (W/O). Catecholamine levels were measured using liquid chromatography-mass spectrometry. Following 208.4 ± 85.5 days of LVAD support, both early and delayed H/M ratios increased by 42.1% (P < 0.001) and 54.7% (P < 0.001), respectively. The W/O rate decreased by 46% (P = 0.003). Plasma norepinephrine, epinephrine, and dopamine decreased significantly in correlation with [(123)I]MIBG parameters. Ten patients had recovered and had their device explanted as they had demonstrated a higher percentage change in delayed H/M ratio, W/O rate, and norepinephrine levels. Linear regression analysis revealed a strong correlation between percentage changes in both norepinephrine and epinephrine and myocardial recovery. CONCLUSION Combination therapy with LVAD and drug resulted in enhancement of [(123)I]MIBG uptake in DCM patients.
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Abstract
Radionuclide cardiac imaging has potential to assess underlying molecular, electrophysiologic, and pathophysiologic processes of cardiac disease. An area of current interest is cardiac autonomic innervation imaging with a radiotracer such as (123)I-meta-iodobenzylguanidine ((123)I-mIBG), a norepinephrine analogue. Cardiac (123)I-mIBG uptake can be assessed by planar and SPECT techniques, involving determination of global uptake by a heart-to-mediastinal ratio, tracer washout between early and delayed images, and focal defects on tomographic images. Cardiac (123)I-mIBG findings have consistently been shown to correlate strongly with heart failure severity, pre-disposition to cardiac arrhythmias, and poor prognosis independent of conventional clinical, laboratory, and image parameters. (123)I-mIBG imaging promises to help monitor a patient's clinical course and response to therapy, showing potential to help select patients for an ICD and other advanced therapies better than current methods. Autonomic imaging also appears to help diagnose ischemic heart disease and identify higher risk, as well as risk-stratify patients with diabetes. Although more investigations in larger populations are needed to strengthen prior findings and influence modifications of clinical guidelines, cardiac (123)I-mIBG imaging shows promise as an emerging technique for recognizing and following potentially life-threatening conditions, as well as improving our understanding of the pathophysiology of various diseases.
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Affiliation(s)
- Mark I Travin
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East-210th Street, Bronx, NY 10467-2490, USA.
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(123)I-MIBG Scintigraphy as a Powerful Tool to Plan an Implantable Cardioverter Defibrillator and to Assess Cardiac Resynchronization Therapy in Heart Failure Patients. INTERNATIONAL JOURNAL OF MOLECULAR IMAGING 2012; 2012:690468. [PMID: 23056938 PMCID: PMC3463902 DOI: 10.1155/2012/690468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 08/22/2012] [Indexed: 11/17/2022]
Abstract
Iodine-123-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy is a nuclear medicine technique which describes the functional status of the cardiac sympathetic nervous system. It is well known that an autonomic dysfunction is present in heart failure setting as a neuronal uptake of norepinephrine is impaired in the failing myocardium. Reduction in sympathetic nervous function in the heart, measured by reduced myocardial uptake of (123)I-MIBG, is an indicator of poor prognosis for heart failure patients. The aim of this paper was to investigate the role of (123)I-MIBG scintigraphy in evaluating the need of implantable cardioverter defibrillator (ICD) and the response to cardiac resynchronization therapy (CRT) in heart failure patients. For this purpose scientific literature data on these topics were reviewed. Based on literature data, (123)I-MIBG scintigraphy seems to be a useful tool to assess which patients may benefit most from an ICD implantation to reduce the risk of ventricular arrhythmia or sudden cardiac death. Furthermore, (123)I-MIBG scintigraphy seems to predict which patients will response to CRT with an improvement in left ventricular function.
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Tanaka H, Tatsumi K, Fujiwara S, Tsuji T, Kaneko A, Ryo K, Fukuda Y, Matsumoto K, Shigeru M, Yoshida A, Kawai H, Hirata KI. Effect of left ventricular dyssynchrony on cardiac sympathetic activity in heart failure patients with wide QRS duration. Circ J 2011; 76:382-9. [PMID: 22130315 DOI: 10.1253/circj.cj-11-0752] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Dyssynchrony has various detrimental effects on cardiac function, but its effect on cardiac sympathetic activity is not fully understood. METHODS AND RESULTS We studied 50 heart failure patients who underwent cardiac resynchronization therapy (CRT). Cardiac sympathetic activity was assessed by (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy as the delayed heart-to-mediastinum ratio (H/M ratio). Echocardiography was performed before and 7 months after CRT, and response was defined as a ≥15% decrease in end-systolic volume. Dyssynchrony was determined by the time difference between the anteroseptal-to-posterior wall using speckle-tracking radial strain (≥130 ms predefined as significant). H/M ratio in patients with dyssynchrony was less than that in patients without dyssynchrony (1.62 ± 0.31 vs. 1.82 ± 0.36, P<0.05), even though ejection fraction was not significantly different (24 ± 6% vs. 25 ± 7%). Patients with dyssynchrony and H/M ratio ≥1.6 had a higher frequency of response to CRT (94%) and favorable long-term outcome over 3.0 years. In contrast, patients without dyssynchrony and H/M ratio <1.6 were more likely to show a lower frequency of response to CRT (0%) and unfavorable long-term outcome after CRT. CONCLUSIONS Dyssynchrony is associated with cardiac sympathetic activity, and (123)I-MIBG scintigraphy may be valuable for predicting the response to CRT.
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Affiliation(s)
- Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan.
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Yu M, Bozek J, Lamoy M, Guaraldi M, Silva P, Kagan M, Yalamanchili P, Onthank D, Mistry M, Lazewatsky J, Broekema M, Radeke H, Purohit A, Cdebaca M, Azure M, Cesati R, Casebier D, Robinson SP. Evaluation of LMI1195, a novel 18F-labeled cardiac neuronal PET imaging agent, in cells and animal models. Circ Cardiovasc Imaging 2011; 4:435-43. [PMID: 21555377 DOI: 10.1161/circimaging.110.962126] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure has been associated with impaired cardiac sympathetic neuronal function. Cardiac imaging with radiolabeled agents that are substrates for the neuronal norepinephrine transporter (NET) has demonstrated the potential to identify individuals at risk of cardiac events. N-[3-Bromo-4-(3-[18F]fluoro-propoxy)-benzyl]-guanidine (LMI1195) is a newly developed 18F-labeled NET substrate designed to allow cardiac neuronal imaging with the high sensitivity, resolution, and quantification afforded by positron emission tomography (PET). METHODS AND RESULTS LMI1195 was evaluated in comparison with norepinephrine (NE) in vitro and 123I-meta-iodobenzylguanidine (MIBG) in vivo. The affinity (Ki) of LMI1195 for NET was 5.16 ± 2.83 μmol/L, similar to that of NE (3.36 ± 2.77 μmol/L) in a cell membrane-binding assay. Similarly, LMI1195 uptake kinetics examined in a human neuroblastoma cell line had Km and Vmax values of 1.44 ± 0.76 μmol/L and 6.05 ± 3.09 pmol/million cells per minute, comparable to NE (2.01 ± 0.85 μmol/L and 6.23 ± 1.52 pmol/million cells per minute). In rats, LMI1195 heart uptake at 15 and 60 minutes after intravenous administration was 2.36 ± 0.38% and 2.16 ± 0.38% injected dose per gram of tissue (%ID/g), similar to 123I-MIBG (2.14 ± 0.30 and 2.19 ± 0.27%ID/g). However, the heart to liver and lung uptake ratios were significantly higher for LMI1195 than for 123I-MIBG. In rabbits, desipramine (1 mg/kg), a selective NET inhibitor, blocked LMI1195 heart uptake by 82%, which was more effective than 123I-MIBG (53%), at 1 hour after dosing. Sympathetic denervation with 6-hydroxydopamine, a neurotoxin, resulted in a marked (79%) decrease in LMI1195 heart uptake. Cardiac PET imaging with LMI1195 in rats, rabbits, and nonhuman primates revealed clear myocardium with low radioactivity levels in the blood, lung, and liver. Imaging in rabbits pretreated with desipramine showed reduced heart radioactivity levels in a dose-dependent manner. Additionally, imaging in sympathetically denervated rabbits resulted in low cardiac image intensity with LMI1195 but normal perfusion images with flurpiridaz F 18, a PET myocardial perfusion imaging agent. In nonhuman primates pretreated with desipramine (0.5 mg/kg), imaging with LMI1195 showed a 66% decrease in myocardial uptake. In a rat model of heart failure, the LMI1195 cardiac uptake decreased as heart failure progressed. CONCLUSIONS LMI1195 is a novel (18)F imaging agent retained in the heart through the NET and allowing evaluation of the cardiac sympathetic neuronal function by PET imaging.
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Affiliation(s)
- Ming Yu
- Discovery Research, Lantheus Medical Imaging, North Billerica, MA 01862, USA.
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Cha YM, Chareonthaitawee P, Dong YX, Kemp BJ, Oh JK, Miyazaki C, Hayes DL, Rea RF, Asirvatham SJ, Webster TL, Dalzell CM, Hodge DO, Herges RM, Yong YZ, Zhang Y, Chen PS. Cardiac Sympathetic Reserve and Response to Cardiac Resynchronization Therapy. Circ Heart Fail 2011; 4:339-44. [DOI: 10.1161/circheartfailure.110.959858] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yong-Mei Cha
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Panithaya Chareonthaitawee
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Ying-Xue Dong
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Bradley J. Kemp
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Jae K. Oh
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Chinami Miyazaki
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - David L. Hayes
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Robert F. Rea
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Samuel J. Asirvatham
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Tracy L. Webster
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Connie M. Dalzell
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - David O. Hodge
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Regina M. Herges
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Yan-zhong Yong
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Yanhua Zhang
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
| | - Peng-Sheng Chen
- From the Division of Cardiovascular Diseases (Y.-M.C., P.C., J.K.O., C.M., D.L.H., R.F.R., S.J.A., T.L.W., C.M.D.), the Department of Radiology, (B.J.K.), and the Division of Biomedical Statistics and Informatics (D.O.H., R.M.H.), Mayo Clinic, Rochester, MN; the Department of Cardiology (Y.-X.D., Y.-z.Y.), the First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; and the Krannert Institute of Cardiology (Y.Z., P.-S.C.), Indiana University School of Medicine, Indianapolis, IN
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Matsuo S, Nakajima K, Kinuya S. Clinical use of nuclear cardiology in the assessment of heart failure. World J Cardiol 2010; 2:344-56. [PMID: 21160612 PMCID: PMC2999043 DOI: 10.4330/wjc.v2.i10.344] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 09/01/2010] [Accepted: 09/08/2010] [Indexed: 02/06/2023] Open
Abstract
A nuclear cardiology test is the most commonly performed non-invasive cardiac imaging test in patients with heart failure, and it plays a pivotal role in their assessment and management. Quantitative gated single positron emission computed tomography (QGS) is used to assess quantitatively cardiac volume, left ventricular ejection fraction (LVEF), stroke volume, and cardiac diastolic function. Resting and stress myocardial perfusion imaging, with exercise or pharmacologic stress, plays a fundamental role in distinguishing ischemic from non-ischemic etiology of heart failure, and in demonstrating myocardial viability. Diastolic heart failure also termed as heart failure with a preserved LVEF is readily identified by nuclear cardiology techniques and can accurately be estimated by peak filling rate (PFR) and time to PFR. Movement of the left ventricle can also be readily assessed by QGS, with newer techniques such as three-dimensional, wall thickening evaluation aiding its assessment. Myocardial perfusion imaging is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Neurotransmitter imaging using (123)I-metaiodobenzylguanidine offers prognostic information in patients with heart failure. Metabolism and function in the heart are closely related, and energy substrate metabolism is a potential target of medical therapies to improve cardiac function in patients with heart failure. Cardiac metabolic imaging using (123)I-15-(p-iodophenyl)3-R, S-methylpentadecacoic acid is a commonly used tracer in clinical studies to diagnose metabolic heart failure. Nuclear cardiology tests, including neurotransmitter imaging and metabolic imaging, are now easily preformed with new tracers to refine heart failure diagnosis. Nuclear cardiology studies contribute significantly to guiding management decisions for identifying cardiac risk in patients with heart failure.
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Affiliation(s)
- Shinro Matsuo
- Shinro Matsuo, Kenichi Nakajima, Seigo Kinuya, Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Ishikawa, Japan
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Mathematical methods to determine quantitative parameters of myocardial 123I-MIBG studies: a review of the literature. Nucl Med Commun 2010; 31:617-28. [PMID: 20220545 DOI: 10.1097/mnm.0b013e328337a99b] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
(123)I-meta-iodobenzyl-guanidine ((123)I-MIBG) scintigraphy is used to visualize and quantify the sympathetic nerve activity. Although it has been used since 1980 to identify myocardial innervation, it is not yet regarded a routine sympathetic imaging agent in this respect. The lack of large multicentre studies and the presence of variations in the protocols that are used for planar MIBG acquisition confines the comparability of study results and application of normal values. Therefore, the aim of this study was to assess the variations in mathematical methods that are currently used to quantify the heart-to-mediastinum ratio and washout rate (WOR). In addition, normal values were evaluated in concordance with these methods. A systematic literature search yielded 169 unique manuscripts, of which 30 contained a complete description of the acquisition protocol for planar MIBG acquisition, image analysis and quantification of the parameters. The results indicate not only large variations in mathematical methods, but also in various aspects of the protocols that are used during acquisition. In many manuscripts method-specific normal values were used; however, these values were generally generated from small, single-centre studies. This study stresses the need to produce guidelines to achieve a standardized method for MIBG acquisition, image analysis and methods to quantify parameters.
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Abstract
Cardiac autonomic function plays a crucial role in health and disease, with abnormalities both reflecting the severity of the disease and contributing specifically to clinical deterioration and poor prognosis. Radiotracer analogs of the sympathetic mediator norepinephrine have been investigated extensively, and are at the brink of potential widespread clinical use. The most widely studied SPECT tracer, I-123 metaiodobenzylguanidine ((123)I-mIBG) has consistently shown a strong, independent ability to risk stratify patients with advanced congestive heart failure. Increased global cardiac uptake appears to have a high negative predictive value in terms of cardiac events, especially death and arrhythmias, and therefore and may have a role in guiding therapy, particularly by helping to better select patients unresponsive to conventional medical therapies who would benefit from device therapies such as an ICD (implantable cardioverter defibrillator), CRT (cardiac resynchronization therapy), LVAD (left ventricular assist device), or cardiac transplantation. Cardiac autonomic imaging with SPECT and PET tracers also shows potential to assess patients following cardiac transplant, those with primary arrhythmic condition, coronary artery disease, diabetes mellitus, and during cardiotoxic chemotherapy. Radiotracer imaging of cardiac autonomic function allows visualization and quantitative measurements of underlying molecular aspects of cardiac disease, and should therefore provide a perspective that other cardiac tests cannot.
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Affiliation(s)
- Sang Yong Ji
- Department of Nuclear Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East-210th Street, Bronx, NY 10467-2490, USA
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Abdallah M, Gerson MC. Advances in Imaging of the Cardiac Neuronal System. CURRENT CARDIOVASCULAR IMAGING REPORTS 2010. [DOI: 10.1007/s12410-010-9018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Long-term follow-up of “reversible” dilated cardiomyopathy with improvement of cardiac sympathetic nerve activity after cardiac resynchronization therapy (CRT). J Cardiol Cases 2010; 1:e56-e62. [DOI: 10.1016/j.jccase.2009.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 06/22/2009] [Accepted: 07/27/2009] [Indexed: 11/21/2022] Open
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Abstract
Cardiac resynchronization has emerged as a highly effective therapy for heart failure. However, up to 40% of patients do not benefit from this treatment. In this Review, we discuss the potential role of MRI and nuclear molecular imaging in providing additional insights into the response to cardiac resynchronization therapy. Variables with potential prognostic and therapeutic values include the evaluation of cardiac dyssynchrony, scar, cardiac sympathetic function, myocardial blood flow, myocardial glucose and oxidative metabolism. Other molecular targets to characterize apoptosis, fatty acid metabolism, angiogenesis and angiotensin-converting enzyme activity will also be described. The potential use of these techniques in identifying and measuring responses to cardiac resynchronization therapy and future areas of research will be explored.
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Cardiac resynchronization therapy and the role of nuclear cardiology. CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0024-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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