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Recent Advances and Clinical Applications of PET Cardiac Autonomic Nervous System Imaging

  • Nuclear Cardiology (V Dilsizian, Section Editor)
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Abstract

Purpose of Review

The purpose of this review was to summarize current advances in positron emission tomography (PET) cardiac autonomic nervous system (ANS) imaging, with a specific focus on clinical applications of novel and established tracers.

Recent Findings

[11C]-Meta-hydroxyephedrine (HED) has provided useful information in evaluation of normal and pathological cardiovascular function. Recently, [11C]-HED PET imaging was able to predict lethal arrhythmias, sudden cardiac death (SCD), and all-cause mortality in heart failure patients with reduced ejection fraction (HFrEF). In addition, initial [11C]-HED PET imaging studies have shown the potential of this agent in elucidating the relationship between impaired cardiac sympathetic nervous system (SNS) innervation and the severity of diastolic dysfunction in HF patients with preserved ejection fraction (HFpEF) and in predicting the response to cardiac resynchronization therapy (CRT) in HFrEF patients. Longer half-life 18F-labeled presynaptic SNS tracers (e.g., [18F]-LMI1195) have been developed to facilitate clinical imaging, although no PET radiotracers that target the ANS have gained wide clinical use in the cardiovascular system. Although the use of parasympathetic nervous system radiotracers in cardiac imaging is limited, the novel tracer, [11C]-donepezil, has shown potential utility in initial studies.

Summary

Many ANS radioligands have been synthesized for PET cardiac imaging, but to date, the most clinically relevant PET tracer has been [11C]-HED. Recent studies have shown the utility of [11C]-HED in relevant clinical issues, such as in the elusive clinical syndrome of HFpEF. Conversely, tracers that target cardiac PNS innervation have been used less clinically, but novel tracers show potential utility for future work. The future application of [11C]-HED and newly designed 18F-labeled tracers for targeting the ANS hold promise for the evaluation and management of a wide range of cardiovascular diseases, including the prognostication of patients with HFpEF.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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  1. Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, 375 Congress Avenue, New Haven, CT, 06519, USA

    Nabil E. Boutagy & Albert J. Sinusas

  2. Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA

    Albert J. Sinusas

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Boutagy, N.E., Sinusas, A.J. Recent Advances and Clinical Applications of PET Cardiac Autonomic Nervous System Imaging. Curr Cardiol Rep 19, 33 (2017). https://doi.org/10.1007/s11886-017-0843-0

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