Molecular imaging in heart failure patients

Abstract

This review focuses on molecular imaging using various radioligands for the tissue characterization of patients with heart failure. 123I-labeled metaiodobenzylguanidine (MIBG), as a marker of adrenergic neuron function, plays an important role in risk stratification in heart failure and may be useful for predicting fatal arrhythmias that may require implantable cardioverter-defibrillator treatment. MIBG has also been used for monitoring treatment effects under various medications. Various positron emission tomography (PET) radioligands have been introduced for the quantitative assessment of presynaptic and postsynaptic neuronal function in vivo. 11C-hydroxyephedrine, like MIBG, has potential for assessing the severity of heart failure. Our PET study using the β-receptor antagonist 11C-CGP 12177 in patients with heart failure showed a reduction of β-receptor density, indicating downregulation, in most of the patients. More studies are needed to confirm the clinical utility of these molecular imaging modalities for the management of heart failure patients.

Cardiac applications of PET

“…PET imaging of cardiac perfusion, metabolism, and sympathetic neuronal function provides valuable information in HF. Figure 4 shows HED PET images in a patient with HF [90]. PET studies in patients with HF demonstrated a reduced cardiac HED uptake and retention, predominantly in apical and inferoapical regions [88,89].…”

“…Reprinted with permission from Springer[90]. A moderate reduction of tracer uptake is noted, particularly in the inferior and posterolateral regions.…”

Cardiac resynchronization therapy and cardiac sympathetic function

“…It has a high affinity for presynaptic neuronal catecholamine transporter (uptake 1) without being metabolized by monoamine oxidases or catechol‐ O ‐methyl‐transferase . A reduction in 11 C‐HED uptake was found to be associated with autonomic dysfunction and low cardiac output in CHF patients, proving to be a negative prognostic marker in these subjects . The aim of the present pilot study was to investigate the acute and chronic changes in cardiac adrenergic activity promoted by CRT, by means of 11 C‐HED PET, to show possible cardiac sympathetic remodulation associated with electromechanical remodelling.…”

“…The positron emitting [ 11 C]‐hidroxyephedrine ( 11 C‐HED) represents a potentially useful tracer for cardiac neuronal imaging. It has a high affinity for presynaptic neuronal catecholamine transporter (uptake 1) without being metabolized by monoamine oxidases or catechol‐ O ‐methyl‐transferase . A reduction in 11 C‐HED uptake was found to be associated with autonomic dysfunction and low cardiac output in CHF patients, proving to be a negative prognostic marker in these subjects .…”

Cardiac neuronal imaging with 123I-meta-iodobenzylguanidine in heart failure: implications of endpoint selection and quantitative analysis on clinical decisions

“…There are a number of radiopharmaceuticals that can be used to investigate autonomic neuronal functions [1]. Among these, the norepinephrine analogue meta-iodobenzylguanidine (MIBG) labelled with 123 I has been widely used and validated as a marker of adrenergic neuron function [2][3][4].…”