Abstract
Life-threatening ventricular arrhythmias (VA) are a major cause of death in patients with congestive heart failure (HF). Among various factors, the sympathetic nervous system may give rise to VA in several pathophysiological pathways due to an impaired function of presynaptic sympathetic nerve terminals. Positron emission tomography (PET) with labeled catecholamine analogues represents a reliable tool to assess the sympathetic innervation activity. This review aims at summarising the most relevant and recent literature findings on the current role of PET in the evaluation of cardiac sympathetic activity in patients with heart failure. A comprehensive literature search strategy using PubMed databases was carried out looking for articles on the role of Positron emission tomography/Computed Tomography (PET/CT) in the assessment of myocardial sympathetic innervation in patients with heart failure. The literature search limited to the last 5 years retrieved 40 papers. Most of the papers dealt with PET studies with 11C-HED. 19 pre-clinical, first-in-human and clinical studies highlighting the current role of PET and future perspectives resulted eligible for inclusion in the present review. The assessment of myocardial sympathetic activity in patients with heart failure with PET will play a pivotal role in clinical practice. Its capability to predict the occurrence of life-threatening VA and the effectiveness of resynchronization therapy makes this technique ideal in the era of personalized medicine.
Highlights
Life-threatening ventricular arrhythmias (VA) are a major cause of death in patients with congestive heart failure (HF)
It is mandatory to identify other variables with prognostic value to predict the occurrence of VA
The sympathetic nervous system may give rise to VA through several pathophysiological pathways including increased global sympathetic activity and regional cardiac sympathetic denervation resulting from ischemia, hibernation, or infarction [2]
Summary
Life-threatening ventricular arrhythmias (VA) are a major cause of death in patients with congestive heart failure (HF). Impaired left ventricular ejection fraction (LVEF) remains the primary criterion for implantable cardioverterdefibrillator therapy to prevent sudden cardiac death, it still has low sensitivity and specificity for the population at risk [1]. An impaired function of presynaptic sympathetic nerve terminals is considered to reflect impaired reuptake and impaired removal of the neurotransmitter from the synaptic cleft [3], resulting in overexposure of the myocardium to catecholamines and in a pre/post-synaptic signaling imbalance [4]. Radionuclide imaging techniques, with Single-Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) imaging, using radiolabeled catecholamines, have been successfully used to identify global and regional impairments of sympathetic nerve terminals in the myocardium and their contribution to disease development and progression
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