The role of radionuclide imaging in heart failure

Abstract

The incidence of heart failure (HF) is increasing and it remains the only area in cardiovascular disease wherein hospitalization rates and mortalities have worsened in the past 25 years. This review is provided to assess the role of radionuclide imaging in HF. The focus is on three aspects: the value of nuclear imaging to distinguish ischemic from non-ischemic etiologies; risk stratification of patients with HF with evaluation of candidates for specific treatment strategies; and the role of cardiac neuronal imaging in patients with HF. Distinguishing ischemic from non-ischemic cardiomyopathy is important because patients with ischemic cardiomyopathy can potentially have dramatic improvement with revascularization. Single photon emission computed tomography (SPECT) has excellent reported sensitivity and negative predictive value in the detection of coronary artery disease in HF patients. SPECT imaging is also useful in establishing treatment strategies in patients with HF, including those with new onset CHF. Cardiac neuronal imaging of mIBG is particularly helpful in risk stratification of patients with HF. The modality can be used to monitor the response to therapy as dysfunctional mIBG uptake may show improvement with pharmacological treatment.

Positron Emission Tomography in Heart Failure: From Pathophysiology to Clinical Application

“…In patients with HF and known or suspected CAD, PET myocardial perfusion imaging is considered the most sensitive imaging technique to predict recovery of LV dysfunction [77][78][79] and it has also emerged as a sensitive prognostic tool [3,80]. Reduced MPR as assessed by PET in patients with ischemic HF was shown to be associated with major adverse cardiac events [79] with a higher sensitivity than reduced LVEF in predicting cardiac death [81].…”

ACR Appropriateness Criteria® Suspected New-Onset and Known Nonacute Heart Failure

“…Tc-99m SPECT/CT MPI Rest and Stress. With SPECT/CT MPI, sensitivity and negative predictive value are both excellent for detecting CAD in patients with HF with either reduced or preserved LVEF; however, the distinction between ischemic and nonischemic etiologies is more characteristic of the evaluation of HFrEF [93,94]. In dyspneic patients with HFrEF without concomitant chest pain, the nonglobal resting LV dysfunction and high-summed stress MPI-deficiency score on gated rest and stress SPECT serve as independent predictors of an ischemic etiology; although low in sensitivity, specificity is acceptable [95].…”

Positionspapier Nuklearkardiologie – Update 2018

“…Bildgebende nuklearkardiologische Verfahren werden auch bei der Diagnostik und Therapie von Kardiomyopathien ein-gesetzt. Ein Indikationsbereich besteht in der Abklärung einer ischämischen gegenüber einer nicht-ischämischen Kardiomyopathie (18,41) und bei der Vitalitätsdiagnostik. Hinsichtlich der Perfusionsdiagnostik ischämischer Kardiomyopathien istsofern verfügbar -aufgrund der überlegenen Abbildungsqualität (Auflösung, Kontrast) und der besseren Perfusionsäquivalenz der PET-Radiopharmaka (in Deutschland meist N-13-Ammoniak) eine PET-CT mit gleichzeitig möglicher quantitativer Perfusionsmessung zu empfehlen.…”