Imaging sympathetic innervation of the heart: Therapeutic strategies SPECT/CT and PET/CT

© Springer-Verlag Berlin Heidelberg 2015. Tracers for radionuclide imaging of cardiac neurotransmission have been developed by radiolabeling true neurotransmitters or corresponding structural analogs (false neurotransmitters). The most commonly used radiopharmaceuticals to assess cardiac neurotransmission are [11 C]-metahydroxyephedrine ([11 C]-mHED), [11 C]-ephedrine, [18 F]-dopamine, and [123 I]-metaiodobenzylguanidine ([123 I]-MIBG), which estimate neuronal presynaptic reuptake (type I uptake) and storage of norepinephrine (NE). In heart failure (HF), there is impairment of the neuronal uptake of NE in the myocardium due to chronic sympathetic activation. Reduced myocardial uptake of these radiotracers is an indicator of poor prognosis for HF patients. Cardiac adrenergic imaging might be useful as an indicator of whether or not the HF patient's medical therapy is effective and could therefore help determine whether higher-risk and usually more expensive device therapies or cardiac transplantation is needed.