Dysinnervated but viable myocardium in ischemic heart disease

Fallavollita, James A.; Canty, John M.

doi:10.1007/s12350-010-9292-5

Cited by 51 publications

(33 citation statements)

References 55 publications

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“…Cardiac 123 I-mIBG imaging is currently indicated for ''scintigraphic assessment of sympathetic innervation of the myocardium in patients with New York Heart Association [NYHA] class II or class III HF and left ventricular ejection fraction [LVEF] B35% … and to help identify patients with lower oneand two-year mortality risks, as indicated by an [HMR] ratio C1.6.'' Nevertheless, much literature suggests a potential broader use, 91 including identification of patients at increased risk of lethal cardiac arrhythmias in the setting of HF, [92][93][94][95] evaluating primary arrhythmic conditions, [96][97][98][99][100] assessing the presence and risk of ischemic heart disease, 101,102 including in situations of hibernating myocardium 103,104 and post-infarction, [105][106][107] evaluating pre-and post-cardiac transplant patients, [108][109][110] identifying diabetic patients at increased risk from cardiac autonomic dysfunction, 111,112 and monitoring toxicity from chemotherapy. 113 However, based on currently available literature, published guidelines, and the FDA package insert, the following indications can be recommended: 114 • For patients with NYHA class II or III heart failure with LVEF B35% to help stratify risk and to promote more informed clinical decision-making when the result of 123 I-mIBG study is likely to influence the decision regarding ICD implant.…”

Section: Tl-201mentioning

confidence: 99%

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Henzlova

Duvall

Einstein

et al. 2016

Journal of Nuclear Cardiology

515

386

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Section: Tl-201mentioning

confidence: 99%

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Henzlova

Duvall

Einstein

et al. 2016

Journal of Nuclear Cardiology

515

386

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“…80 PET tracers such as 11C-hydroxyephedrine (11-CHED) improve the signal-noise ratio allowing better quantification. 81 The recent Prediction of Arrhythmic Events with Positron Emission Tomography (PAREPET) study 82 has proved that the extent of uptake defects correlated with the occurrence of SCD or ICD discharge.…”

Section: Sympathetic Activitymentioning

confidence: 99%

Novel Imaging Techniques for Heart Failure

Melero-Ferrer

López‐Vilella

Morillas-Climent

et al. 2016

Cardiac Failure Review

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Heart failure (HF) is an epidemic with an increasing prevalence and an absolute mortality rate of approximately 50 % within 5 years of diagnosis. Imaging plays a main role in HF diagnosis, assessment of aetiology and treatment guidance. This article reviews current HF applications for all the available non-invasive imaging modalities: echocardiography, cardiovascular magnetic resonance (CMR), nuclear imaging-positron emission tomography (PET) and single-photon emission computed tomography (SPECT) and computed tomography (CT). Echocardiography, with its recent developments, such as 3D echo, is the main imaging test used in the evaluation of HF patients, given its availability and reliability in assessing cardiac structure and function. CMR allows the characterisation of myocardial tissue, in addition to providing information on the structure and cardiac function, so it is a great help in the determination of HF aetiology and may predict patient outcomes. Nuclear imaging can detect ischaemia and viability and can obtain additional prognostic data. Cardiac CT is EchocardiographyAlthough echocardiography is a relatively 'ancient' technique, its versatility makes it unique in the provision of volumes, function, haemodynamics or valvular regurgitation. In addition, because of its availability, safety and low cost, echocardiography is the first and most widely used test for the diagnosis, selection of appropriate treatment and prognosis of HF.1 Echocardiography is also the most used imaging method in the reassessment of HF patients. It remains unclear when to repeat echocardiographic exams, but it is deemed appropriate at least in patients with worsening symptoms. Systolic FunctionGlobal left ventricular (LV) function is of paramount importance regarding therapeutic decisions. Visual estimation of ejection fraction (EF), the Teichholz and Simpson methods, have been widely validated. 2,3However, in 2D imaging, because of its operator-dependent nature, repeated testing has a high probability of producing variable volume and EF results.The apparition of 3D fully sampled matrix transthoracic echocardiography has enabled easier acquisition of images, 4 simplifying its routinary application. There have been many studies comparing 2D and 3D echocardiography (2DE and 3DE) and a 'reference' standard (generally CMR). A recent meta-analysis of all 3DE studies evaluating LV volumes and EF demonstrated that 3DE generally underestimated volumes, but not as significantly as 2DE. There was also less variability than 2D compared with CMR.5 Nonetheless, 3DE echocardiography may be challenging and not practical in patients with low image quality (e.g. critical patients), in whom 2DE measures are more realiable. 3DE is also a less standardised techique than 2DE, and because of this reason most laboratories use the more universally applicable 2DE measurements in clinical practice. Only recently, large analyses of LV parameters using 3DE in large cohorts of healthy individuals have been published to establish race, age and gender-specific ...

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“…25 Although indirect radionuclide assessment of arrhythmic risk has been described through determination of the extent and severity of perfusion imaging defects, 26 cardiac autonomic innervation imaging is a promising method for directly assessing arrhythmic risk. [27][28][29][30][31][32] Innervation abnormalities can contribute to initiating and sustaining arrhythmias by creating substrate abnormalities resulting in heterogeneity of sympathetic innervation, 28 increasing systemic autonomic tone that can trigger an arrhythmia in denervated hypersensitive myocardium, 29 and via modulation of central and regional autonomic tone that can accentuate electric heterogeneities of primary arrhythmic conditions. 26 Human work has been limited to assessing sympathetic innervation and uses analogues of norepinephrine.…”

Section: Radionuclide Imagingmentioning

confidence: 99%

Novel Imaging Approaches for Predicting Arrhythmic Risk

Travin

Feng

Taub

2015

Circ: Cardiovascular Imaging

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Abstract-Determination of ventricular arrhythmic risk is crucial for guiding management of cardiac disease. Although for patients at increased risk an implantable cardioverter-defibrillator is recommended, it is widely acknowledged that current criteria for device use based predominantly on left ventricular ejection fraction are deficient. Genesis of ventricular arrhythmias involves a complex interaction of myocardial substrate abnormalities, precipitating triggers, and modulating factors. There are much data showing that by more directly assessing these factors, noninvasive imaging using echocardiography, radionuclide imaging, and cardiac magnetic resonance enhances arrhythmic risk stratification beyond ejection fraction and commonly used electrocardiographic and serum biomarkers. It is anticipated that further technological advancements studied in well-designed clinical trials will provide both more precise determination of risk and guide therapies to enhanced survival and patient well-being.

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Dysinnervated but viable myocardium in ischemic heart disease

Cited by 51 publications

References 55 publications

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Novel Imaging Techniques for Heart Failure

Novel Imaging Approaches for Predicting Arrhythmic Risk

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