Presence of sympathetically denervated but viable myocardium and its electrophysiologic correlates after early revascularised, acute myocardial infarction

Simões, Marcus Vinı́cius; Barthel, Petra; Matsunari, Ichiro; Nekolla, Stephan G.; Schömig, Albert; Schwaiger, Markus; Schmidt, Georg; Bengel, Frank M.

doi:10.1016/j.ehj.2004.02.016

Cited by 115 publications

(77 citation statements)

References 25 publications

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“…78 The extent or severity of autonomic defects predicted VT inducibility 79 and occurrence of an ICD discharge or SCD. 80 PET tracers such as 11C-hydroxyephedrine (11-CHED) improve the signal-noise ratio allowing better quantification.…”

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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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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“…The rationale for SPECT is that the presence of regional autonomic tracer defects, particularly if tracer uptake is relatively preserved on a separately obtained standard rest perfusion image, i.e., an autonomic/perfusion mismatch, may indicate potential for electrical heterogeneity and denervation supersensitivity, pre-disposing to potentially lethal arrhythmias. 56,57 While there is no officially established method for scoring SPECT 123 I-mIBG images, analysis can be performed similar to the conventional 17-segment method used for MPI, with generation of a summed score. 37,58 However, a key difference for 123 I-mIBG images is that when there is globally decreased uptake, homogeneous tracer uptake cannot be scored as normal as, unlike the custom for perfusion images, one cannot assume a ''normal'' region.…”

Section: Image Analysis and Interpretationmentioning

confidence: 99%

“…56,[134][135][136][137] Injury to sympathetic innervation may persist after myocyte recovery, resulting in areas of autonomic/perfusion mismatch, possibly pre-disposing to post-MI arrhythmias. 57,[138][139][140] Tomoda et al 141 showed that 3-4 weeks after nonST segment elevation MI, 123 I-mIBG defects may be present without Tl-201 perfusion defects. 123 I-mIBG defects can occur following angina, 142 and may be present up to 6 months after coronary spasm.…”

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confidence: 99%

Cardiac autonomic imaging with SPECT tracers

Travin

2013

Journal of Nuclear Cardiology

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“…For example, simultaneously investigating myocardial sympathetic innervation and perfusion/ viability may help in the identification of the pro-arrhythmic, denervated but viable infarct borderzone [13,14]. Alternatively, very specific insights may be provided by combining information on myocardial sympathetic activity and various agents identifying, for example apoptosis, extracellular matrix activation, or angiogenesis [15].…”

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confidence: 99%

What future for the myocardial sympathetic innervation imaging?

Caobelli

2017

Eur J Nucl Med Mol Imaging

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The myocardial sympathetic innervation plays a pivotal role in the progression of heart failure and in the occurrence of lifethreatening arrhythmias. An impaired function of presynaptic sympathetic nerve terminals is considered to reflect impaired reuptake and thus impaired removal of the neurotransmitter from the synaptic cleft [1], resulting in overexposure of the myocardium to catecholamines and in a pre/post-synaptic signaling imbalance [2]. Consistent with this pathophysiologic model, prospective, large-scale clinical trials confirmed an excellent prognostic value of adrenergic imaging in patients with heart failure, both with single photon emission tomography (SPECT) and with positron emission tomography (PET) [3,4].Although extensively validated and embedded in clinical practice, the study of myocardial sympathetic innervation activity with standard SPECT suffers from evident limitations. In fact, its main prognostic parameters, i.e., the heart-tomediastinum ratio and the cardiac washout rate, are generally derived from planar scans of the chest, thus allowing only for a semiquantitative evaluation of the global activity of sympathetic innervation. But as underlined also by a recent report, the heterogeneity of innervation may be more prognostically relevant than the assessment of the degree of sympathetic denervation [5]. As such, an imaging modality able to allow for a regional assessment of myocardial sympathetic innervation would be highly desirable. In this regard, new heart dedicated camera systems equipped with cadmium-zinc-telluride (CZT) solidstate detectors may constitute a valid alternative. Owing to improved image quality and temporal and spatial resolution over standard SPECT, a regional assessment of sympathetic innervation activity is feasible and accurate [6,7]. Unfortunately, despite its great advantages, this novel, recently available SPECT technology is not widely deployed yet.Hence, PET may be a preferred technique for the assessment of the cardiac sympathetic nervous system, able to yield a significantly higher impact on clinical practice. PET provides superior sensitivity and resolution over conventional nuclear imaging, thus allowing for a precise localization of innervation defects. To date, the main limitation of PET relates in the need of an on-site cyclotron, which is required to produce 11

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Presence of sympathetically denervated but viable myocardium and its electrophysiologic correlates after early revascularised, acute myocardial infarction

Cited by 115 publications

References 25 publications

Novel Imaging Techniques for Heart Failure

Novel Imaging Techniques for Heart Failure

Cardiac autonomic imaging with SPECT tracers

What future for the myocardial sympathetic innervation imaging?

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