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Cardiac Sympathetic Innervation Imaging with PET Radiotracers

  • Nuclear Cardiology (V Dilsizian, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The present article reviews the pathophysiology of cardiac sympathetic denervation, the principles of positron emission tomography (PET) imaging of the sympathetic innervation of the heart and its potential clinical role, based on current and expected future evidence.

Recent Findings

Imaging of cardiac sympathetic denervation can be performed with radiolabeled noradrenaline analogues, e.g., 11C-hydroxyephedrine. A greater burden of sympathetic denervation carries prognostic significance, e.g., in patients with ischemic cardiomyopathy and a left ventricular ejection fraction ≤ 35%, who are more likely to experience sudden cardiac death. Abnormalities of sympathetic cardiac innervation have been demonstrated in hypertrophic, dilated, and arrhythmic right ventricular cardiomyopathies, and may be helpful in better phenotyping patients who will benefit from device therapy, e.g., cardiac resynchronization and implantable cardioverter-defibrillator implantation. The results of future trials, e.g., the Prediction of Arrhythmic Events with Positron Emission Tomography (PAREPET) II study, are awaited to inform on the role of PET cardiac sympathetic imaging in the selection of device therapy.

Summary

PET cardiac sympathetic innervation imaging allows visualization and quantification of autonomic denervation secondary to various cardiac diseases, and has significant potential to influence clinical decision-making, e.g., the titration of pharmacotherapy and more directed selection of candidates for device implantation.

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Authors and Affiliations

  1. Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands

    Pieter van der Bijl, Victoria Delgado & Jeroen J. Bax

  2. Turku PET Center, Turku University Hospital, Turku, Finland

    Juhani Knuuti

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  1. Pieter van der Bijl
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Correspondence to Jeroen J. Bax.

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Conflict of Interest

The Department of Cardiology of the Leiden University Medical Center received unrestricted research grants from Abbott Vascular, Bayer, Bioventrix, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare, and Medtronic. Pieter van der Bijl has nothing to disclose. Juhani Knuuti received speaker fees from GE Healthcare, Bayer, Lundbeck, and Merck; and fees from AstraZeneca and GE Healthcare for study protocol commenting. Victoria Delgado received speaker fees from Abbott Vascular, MSD, Medtronic, Edwards Lifesciences, and GE Healthcare. Jeroen J. Bax received speaker fees from Abbott Vascular.

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van der Bijl, P., Knuuti, J., Delgado, V. et al. Cardiac Sympathetic Innervation Imaging with PET Radiotracers. Curr Cardiol Rep 23, 4 (2021). https://doi.org/10.1007/s11886-020-01432-9

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