Abstract

Cardiac sympathetic activity plays a key role in supporting cardiac function in both health and disease conditions, and nuclear cardiac imaging has always represented the only way for the non-invasive evaluation of the functional integrity of cardiac sympathetic terminals, mainly through the use of radiopharmaceuticals that are analogues of norepinephrine and, in particular, with the use of 123I-mIBG imaging. This technique demonstrates the presence of cardiac sympathetic dysfunction in different cardiac pathologies, linking the severity of sympathetic nervous system impairment to adverse patient's prognosis. This article will outline the state-of-the-art of cardiac 123I-mIBG imaging and define the value and clinical applications in the different fields of cardiovascular diseases.

Highlights

  • Cardiac sympathetic activity plays a key role in supporting cardiac function in both health and disease conditions, a mechanism operated by released norepinephrine (NE),[1,2,3] the physiological neurotransmitter binding alpha- and beta-adrenoceptors and undergoing reuptake by presynaptic and extra-neuronal transporters.[4]

  • Based on current evidence, 123I-mIBG scintigraphy might be of value in the risk stratification of patients with chronic heart failure (CHF), possibly contributing in identifying patients at increased risk that could benefit from more aggressive therapeutic/invasive approaches,[28] in the case of patients currently excluded from prophylactic implantable cardioverter defibrillator (ICD) implantation.[29]

  • The interpretation of myocardial innervation imaging requires the knowledge of different topics: neuronal biology, tracer kinetics, and the specific disease state

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Summary

University of Groningen

The role of myocardial innervation imaging in different clinical scenarios Gimelli, Alessia; Liga, Riccardo; Agostini, Denis; Bengel, Frank M.; Ernst, Sabine; Hyafil, Fabien; Saraste, Antti; Scholte, Arthur J. H. A.; Verberne, Hein J.; Verschure, Derk O. Citation for published version (APA): Gimelli, A., Liga, R., Agostini, D., Bengel, F. The role of myocardial innervation imaging in different clinical scenarios: an expert document of the European Association of Cardiovascular Imaging and Cardiovascular Committee of the European Association of Nuclear Medicine. More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverneamendment. European Heart Journal - Cardiovascular Imaging (2021) 22, 480–490 doi:10.1093/ehjci/jeab[007]

EACVI DOCUMENT
Introduction
Myocardial innervation imaging in patients with CHF
Myocardial innervation imaging as predictor of ventricular arrhythmias
Myocardial innervation imaging in patients with atrial fibrillation
Myocardial innervation imaging in patients with amyloidosis
Myocardial innervation imaging in diabetic patients
Myocardial innervation imaging in Takotsubo
Myocardial innervation imaging in neurodegenerative diseases
Planar imaging
Future perspectives
Conclusions
Findings
Liability statement

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