Cardiac Sympathetic Imaging in Heart Failure
Summary
Heart failure is characterised by impaired cardiac function and a dysregulated autonomic balance, with heightened sympathetic activity contributing to disease progression and adverse outcomes. Cardiac sympathetic imaging enables non-invasive visualisation and quantification of myocardial innervation, offering insights into nerve integrity, receptor density and neurotransmitter handling. Traditional techniques employ single-photon emission computed tomography (SPECT) with 123I-metaiodobenzylguanidine (MIBG), yielding metrics such as the heart-to-mediastinum ratio and washout rate to stratify risk and guide therapy. More recent advances in positron emission tomography (PET) tracers targeting the norepinephrine transporter have improved spatial resolution and kinetic modelling, facilitating precise assessment of regional denervation and reinnervation. Standardisation efforts, including phantom-based cross-calibration protocols, have minimised inter-institutional variability, ensuring reproducibility of quantitative parameters. Clinical applications span prognostic modelling for mortality and arrhythmic events, optimisation of implantable device selection and evaluation of novel pharmacotherapies aimed at modulating sympathetic tone. Emerging approaches integrate machine learning algorithms with imaging biomarkers to differentiate modes of cardiac death and refine individualised risk prediction. Together, these innovations underscore the global significance of cardiac sympathetic imaging as a tool for personalised management in heart failure, bridging fundamental research and routine clinical practice.
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Cardiac Sympathetic Imaging in Heart Failure publication trend
The graph below shows the total number of articles in cardiac sympathetic imaging in heart failure across all publications each year (not limited to Nature Index journals).
Technical terms
Heart-to-mediastinum ratio (HMR): Semi-quantitative index of myocardial tracer uptake relative to a mediastinal region, used to assess sympathetic nerve density.
Washout rate: Percentage change in tracer retention between early and delayed images, reflecting norepinephrine turnover.
Single-photon emission computed tomography (SPECT): Nuclear imaging technique that produces three-dimensional tomographic images from gamma-ray emission.
Positron emission tomography (PET): High-resolution imaging modality detecting positron-emitting radiotracers for quantitative assessment of molecular targets.
Norepinephrine transporter (NET): Membrane protein responsible for uptake of norepinephrine into presynaptic nerve terminals, targeted by specific radiotracers.
Standardized uptake value (SUV): Quantitative PET metric normalised for injected dose and patient bodyweight, indicating regional tracer concentration.
References
- Rationalizing the Binding Modes of PET Radiotracers Targeting the Norepinephrine Transporter. Pharmaceutics (2023).
- Diagnostic Efficacy of 123Iodo-Metaiodobenzylguanidine SPECT/CT in Cardiac vs. Neurological Diseases: A Comparative Study of Arrhythmogenic Right Ventricular Cardiomyopathy and α-Synucleinopathies. Diagnostics (2024).
- Standardization of 123I-meta-iodobenzylguanidine myocardial sympathetic activity imaging: phantom calibration and clinical applications. Clinical and Translational Imaging (2017).
- Cardiac sympathetic activity in chronic heart failure: cardiac 123I-mIBG scintigraphy to improve patient selection for ICD implantation. Netherlands Heart Journal (2016).
- Machine learning-based risk model using 123I-metaiodobenzylguanidine to differentially predict modes of cardiac death in heart failure. Journal of Nuclear Cardiology (2020).
- The prognostic value of 123I-mIBG SPECT cardiac imaging in heart failure patients: a systematic review. Journal of Nuclear Cardiology (2021).
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