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How do we establish cardiac sympathetic nervous system imaging with 123I-mIBG in clinical practice? Perspectives and lessons from Japan and the US

  • International Corner
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Cardiac denervation is associated with progressive left ventricular (LV) dysfunction, ventricular arrhythmias, and sudden cardiac death (SCD) in heart failure (HF). In this regard, it is important to evaluate cardiac-specific sympathetic nervous system (SNS) function. The radiotracer Iodine-123 meta-iodobenzylguanidine (123I-mIBG) can noninvasively evaluate pre-synaptic SNS function. Recent multicenter trials have shown 123I-mIBG to have strong predictive value for fatal arrhythmias and cardiac death in HF. 123I-mIBG was initially developed in the USA in the 1970s. In 1992, the Japanese Ministry of Health and Labour approved 123I-mIBG for the assessment of cardiac function. Following approval, the Japanese nuclear cardiology community developed 123I-mIBG imaging services in various medical centers. Japanese groups have been trying to establish the clinical utility of 123I-mIBG and standardize parameters for data acquisition and image analysis. The US Food and Drug Administration (FDA) has approved clinical use of 123I-mIBG for cardiac and non-cardiac imaging. However, clinical use of 123I-mIBG in the US has been very limited. The number of 123I-mIBG studies in Japan has also been limited. There are similarities and differences between the two countries. To establish the clinical utility of 123I-mIBG in both countries, it is important to characterize the situations of 123I-mIBG in each.

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Abbreviations

SNS:

Sympathetic nervous system

123I-mIBG:

Iodine-123 meta-iodobenzylguanidine

SCD:

Sudden cardiac death

FDA:

Food and Drug Administration

JMHLW:

Japanese Ministry of Health, Labour and Welfare

SPECT:

Single photon emission computed tomography

HF:

Heart failure

HMR:

Heart-to-mediastinum ratio

ICD:

Implantable carioverter defibrillator

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Acknowledgments

The authors thank Natsue Ito, MT, for her support in preparing this manuscript. The authors thank Mariko Yamasaki, MA, for her administrative assistance. Prior to submission, the manuscript was reviewed by a North American English-language professional editor, Holly Beanlands; the authors thank her for critical reading of the manuscript.

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The authors declare that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiology/Division of Nuclear Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Mark I. Travin MD, FACC, MASNC

  2. Division of Nuclear Medicine, Department of Radiology, Saitama Medical University, Moroyama, Japan

    Ichiro Matsunari MD, PhD

  3. Memorial Care Heart, & Vascular Institute, Long Beach Medical Center, Long Beach, CA, USA

    Gregory S. Thomas MD, MPH, FACC, MASNC

  4. Division of Cardiology, University of California, Irvine, Orange, CA, USA

    Gregory S. Thomas MD, MPH, FACC, MASNC

  5. Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan

    Kenichi Nakajima MD, PhD

  6. Diagnostic and Therapeutic Nuclear Medicine, National Institutes for Quantum and Radiological Science and Technology, National Institute of Radiological Sciences, Chiba, Japan

    Keiichiro Yoshinaga MD, PhD, FACC, FASNC

Authors
  1. Mark I. Travin MD, FACC, MASNC
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  2. Ichiro Matsunari MD, PhD
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  3. Gregory S. Thomas MD, MPH, FACC, MASNC
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  4. Kenichi Nakajima MD, PhD
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  5. Keiichiro Yoshinaga MD, PhD, FACC, FASNC
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Corresponding author

Correspondence to Keiichiro Yoshinaga MD, PhD, FACC, FASNC.

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This article is being jointly published in the Journal of Nuclear Cardiology and the Annals of Nuclear Cardiology.

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Travin, M.I., Matsunari, I., Thomas, G.S. et al. How do we establish cardiac sympathetic nervous system imaging with 123I-mIBG in clinical practice? Perspectives and lessons from Japan and the US. J. Nucl. Cardiol. 26, 1434–1451 (2019). https://doi.org/10.1007/s12350-018-1394-5

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  • DOI: https://doi.org/10.1007/s12350-018-1394-5

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