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Filipović N, Marinović Guić M, Košta V, Vukojević K. Cardiac innervations in diabetes mellitus-Anatomical evidence of neuropathy. Anat Rec (Hoboken) 2023; 306:2345-2365. [PMID: 36251628 DOI: 10.1002/ar.25090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/09/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
The extensive innervations of the heart include a complex network of sympathetic, parasympathetic, and sensory nerves connected in loops that serve to regulate cardiac output. Metabolic dysfunction in diabetes affects many different organ systems, including the cardiovascular system; it causes cardiac arrhythmias, silent myocardial ischemia, and sudden cardiac death, among others. These conditions are associated with damage to the nerves that innervate the heart, cardiac autonomic neuropathy (CAN), which is caused by various pathophysiological mechanisms. In this review, the main facts about the anatomy of cardiac innervations and the current knowledge of CAN, its pathophysiological mechanisms, and its diagnostic approach are discussed. In addition, anatomical evidence for CAN from human and animal studies has been summarized.
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Affiliation(s)
- Natalija Filipović
- Department of Anatomy, Histology and Embryology, Laboratory for Experimental Neurocardiology, University of Split School of Medicine, Split, Croatia
| | - Maja Marinović Guić
- Department of Diagnostic and Interventional Radiology, University Hospital of Split, Split, Croatia
- University Department of Health Studies, University of Split, Split, Croatia
| | - Vana Košta
- Department of Neurology, University Hospital of Split, Split, Croatia
| | - Katarina Vukojević
- Department of Anatomy, Histology and Embryology, Laboratory for Experimental Neurocardiology, University of Split School of Medicine, Split, Croatia
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Evtushenko A, Evtushenko V, Gusakova A, Suslova T, Varlamova Y, Zavadovskiy K, Lebedev D, Kutikhin A, Pavlyukova E, Mamchur S. Neurohumoral Markers of Cardiac Autonomic Denervation after Surgical Ablation of Long-Standing Persistent Atrial Fibrillation. Life (Basel) 2023; 13:1340. [PMID: 37374123 PMCID: PMC10300786 DOI: 10.3390/life13061340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Although the autonomic nervous system has an evident impact on cardiac electrophysiology and radiofrequency ablation (RFA) is the conventional technique for treating persistent atrial fibrillation, the specific effects of RFA have been insufficiently studied to date. Here, we investigated whether RFA affects neurohumoral transmitter levels and myocardial 123I-metaiodobenzylguanidine (123I-MIBG) uptake. To perform this task, we compared two groups of patients with acquired valvular heart disease: patients who had undergone surgical AF ablation and patients with sinus rhythm. The decrease in norepinephrine (NE) level in the coronary sinus had a direct association with the heart-to-mediastinum ratio (p = 0.02) and a negative correlation with 123I-MIBG uptake defects (p = 0.01). The NE level decreased significantly after the main surgery, both in patients with AF (p = 0.0098) and sinus rhythm (p = 0.0039). Furthermore, the intraoperative difference between the norepinephrine levels in the ascending aorta and coronary sinus (ΔNE) of -400 pg/mL was determined as a cut-off value to evaluate RFA efficacy, as denervation failed in all patients with ΔNE < -400 pg/mL. Hence, ΔNE can be utilized to predict the efficacy of the "MAZE-IV" procedure and to assess the risk of AF recurrence after RFA.
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Affiliation(s)
- Alexey Evtushenko
- Department of Cardiovascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.E.); (S.M.)
| | - Vladimir Evtushenko
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Anna Gusakova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Tatiana Suslova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Yulia Varlamova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Konstantin Zavadovskiy
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Denis Lebedev
- Department of Cardiovascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.E.); (S.M.)
| | - Anton Kutikhin
- Department of Cardiovascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.E.); (S.M.)
| | - Elena Pavlyukova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya Street, Tomsk 634012, Russia
| | - Sergey Mamchur
- Department of Cardiovascular Surgery, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, Kemerovo 650002, Russia; (A.E.); (S.M.)
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Marwick TH, Gimelli A, Plein S, Bax JJ, Charron P, Delgado V, Donal E, Lancellotti P, Levelt E, Maurovich-Horvat P, Neubauer S, Pontone G, Saraste A, Cosyns B, Edvardsen T, Popescu BA, Galderisi M, Derumeaux G, Bäck M, Bertrand PB, Dweck M, Keenan N, Magne J, Neglia D, Stankovic I. Multimodality imaging approach to left ventricular dysfunction in diabetes: an expert consensus document from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2022; 23:e62-e84. [PMID: 34739054 DOI: 10.1093/ehjci/jeab220] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/14/2023] Open
Abstract
Heart failure (HF) is among the most important and frequent complications of diabetes mellitus (DM). The detection of subclinical dysfunction is a marker of HF risk and presents a potential target for reducing incident HF in DM. Left ventricular (LV) dysfunction secondary to DM is heterogeneous, with phenotypes including predominantly systolic, predominantly diastolic, and mixed dysfunction. Indeed, the pathogenesis of HF in this setting is heterogeneous. Effective management of this problem will require detailed phenotyping of the contributions of fibrosis, microcirculatory disturbance, abnormal metabolism, and sympathetic innervation, among other mechanisms. For this reason, an imaging strategy for the detection of HF risk needs to not only detect subclinical LV dysfunction (LVD) but also characterize its pathogenesis. At present, it is possible to identify individuals with DM at increased risk HF, and there is evidence that cardioprotection may be of benefit. However, there is insufficient justification for HF screening, because we need stronger evidence of the links between the detection of LVD, treatment, and improved outcome. This review discusses the options for screening for LVD, the potential means of identifying the underlying mechanisms, and the pathways to treatment.
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Affiliation(s)
- Thomas H Marwick
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Center & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Phillippe Charron
- Sorbonne Université, INSERM UMRS 1166 and ICAN Institute, Paris, France
- APHP, Centre de référence pour les maladies cardiaques héréditaires ou rares, Hôpital Pitié-Salpêtrière, Paris, France
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2300RC, The Netherlands
| | - Erwan Donal
- Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000 Rennes, France
- Université de Rennes 1, LTSI, 35000 Rennes, France
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU SartTilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Eylem Levelt
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital , Groby Road, Leicester LE3 9QF, UK
| | - Pal Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, 2 Koranyi u., 1083 Budapest, Hungary
| | - Stefan Neubauer
- Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Headley Way, Oxford OX3 9DU, UK
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, University of Milan, Cardiovascular Imaging, Milan, Italy
| | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland
- Heart Center, Turku University Hospital, Turku, Finland
| | - Bernard Cosyns
- Cardiology, CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair ziekenhuis Brussel, 109 Laarbeeklaan, Brussels 1090, Belgium
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Postbox 4950 Nydalen, Sognsvannsveien 20, NO-0424 Oslo, Norway
- Institute for clinical medicine, University of Oslo, Sognsvannsveien 20, NO-0424 Oslo, Norway
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Genevieve Derumeaux
- IMRB - Inserm U955 Senescence, metabolism and cardiovascular diseases 8, rue du Général Sarrail, 94010 Créteil, France
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Leite JC, Brandão DC, Brandão SCS, Fuzari HKB, Vidal TM, Frutuoso J, Remígio MI, de Araújo BTS, Campos SL, Dornelas de Andrade A. Effectiveness of inspiratory muscle training associated with a cardiac rehabilitation program on sympathetic activity and functional capacity in patients with heart failure: a study protocol for a randomized controlled trial. Trials 2020; 21:519. [PMID: 32532283 PMCID: PMC7291458 DOI: 10.1186/s13063-020-04363-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals affected by heart failure (HF) may present fatigue, dyspnea, respiratory muscle weakness, and sympathetic activity hyperstimulation of the myocardium, among other symptoms. Conducting cardiac rehabilitation (CR) programs can be associated with inspiratory muscle training. The aim of this study was to evaluate the efficacy of inspiratory muscular training (IMT) associated with a CR program on modulating myocardial sympathetic activity and maximal functional capacity, submaximal functional capacity, thickness, and mobility of the diaphragm muscle in patients with HF. METHODS We will conduct a clinical, controlled, randomized, double-blind trial that will include sedentary men and women who are 21-60 years old and who have diagnosed systolic HF and a left ventricular ejection fraction of less than 45%. Participants will be randomly assigned to one of two groups: experimental and control. The control group will follow the conventional CR protocol, and the experimental group will follow the conventional CR protocol associated with IMT 7 days a week. The two proposed exercise protocols will have a frequency of three times a week for a period of 12 weeks. The sympathetic innervation of the cardiac muscle, the maximum and submaximal functional capacity, diaphragm mobility and thickness, and the quality of life of the participants will be evaluated before and after the intervention protocol. DISCUSSION This clinical trial will be the first study to investigate the additional effects of IMT on CR in sympathetic hyperstimulation in the myocardium. The results of this study will contribute to developing therapeutic strategies collaborating to elucidate whether the association of IMT with CR can induce clinical benefits for patients with HF. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02600000. Registered November 9, 2015. Retrospectively registered.
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Affiliation(s)
- Jéssica Costa Leite
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Av. Senador Salgado Filho, s/n, Natal, 59078-970 Rio Grande do Norte Brazil
| | - Daniella Cunha Brandão
- Department of Physiotherapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, s / n, Recife, Pernambuco 50740-560 Brazil
| | - Simone Cristina Soares Brandão
- Nuclear Medicine and Cardiology Services, Hospital das Clínicas de Pernambuco, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, 50670-901 Pernambuco Brazil
| | - Helen Kerlen Bastos Fuzari
- Department of Physiotherapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, s / n, Recife, Pernambuco 50740-560 Brazil
| | - Tainá Maria Vidal
- Department of Physiotherapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, s / n, Recife, Pernambuco 50740-560 Brazil
| | - Jasiel Frutuoso
- Department of Physiotherapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, s / n, Recife, Pernambuco 50740-560 Brazil
| | - Maria Inês Remígio
- Department of Clinical Semiology of the Medicine Faculty, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, s / n, Cidade Universitária, Recife, 50740-560 Pernambuco Brazil
| | - Bruna Thays Santana de Araújo
- Department of Physiotherapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, s / n, Recife, Pernambuco 50740-560 Brazil
| | - Shirley Lima Campos
- Department of Physiotherapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, s / n, Recife, Pernambuco 50740-560 Brazil
| | - Armele Dornelas de Andrade
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Av. Senador Salgado Filho, s/n, Natal, 59078-970 Rio Grande do Norte Brazil
- Department of Physiotherapy, Universidade Federal de Pernambuco, Av. Jornalista Aníbal Fernandes, s / n, Recife, Pernambuco 50740-560 Brazil
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Jeong YJ, Jeong JE, Cheon SM, Yoon BA, Kim JW, Kang DY. Relationship between the washout rate of I-123 MIBG scans and autonomic function in Parkinson's disease. PLoS One 2020; 15:e0229860. [PMID: 32134983 PMCID: PMC7058312 DOI: 10.1371/journal.pone.0229860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/19/2020] [Indexed: 01/18/2023] Open
Abstract
Purpose We have evaluated the clinical significance of the washout rate (WR) on I-123 MIBG scans through the analysis of the relationship between the I-123 MIBG scans and autonomic status in patients with Parkinson’s disease (PD). Materials and methods Sixty patients with clinical PD who had decreased HMR were enrolled. An autonomic symptom was evaluated using a head-up tilt test and the Composite Autonomic Severity Score (CASS). An I-123 MIBG scan and F-18 FP-CIT positron emission tomography (PET) were performed. All of the patients were classified into three groups according to the WR. The differences in patient characteristics and the imaging parameters among the three groups were evaluated, and a correlation analysis was also performed. Results The frequency of orthostatic hypotension was significantly different among the three groups. The difference in systolic pressure (dSysPr) and the difference in diastolic pressure (dDiaPr) of group 3 was significantly larger than those of groups 1 and 2. From the correlation analysis, it can be seen that age, Hoehn and Yahr (H&Y) stage, dSysPr, and dDiaPr had a weak positive correlation with the WR. The total CASS score was significantly higher in group 3 compared with groups 1 and 2. The WR had a moderate positive correlation with the cardiosympathetic score and the total CASS score. Conclusion The WR is related to autonomic dysfunction. An I-123 MIBG cardiac scan is considered to be a good method to evaluate not only the differential diagnosis of Parkinson's disease but also the degree of autonomic dysfunction.
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Affiliation(s)
- Young Jin Jeong
- Departments of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
- Institute of Convergence Bio-Health, Dong-A University, Busan, Republic of Korea
| | - Ji-Eun Jeong
- Departments of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Sang-Myung Cheon
- Departments of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Byeol-A Yoon
- Departments of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jae Woo Kim
- Departments of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Do-Young Kang
- Departments of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
- Institute of Convergence Bio-Health, Dong-A University, Busan, Republic of Korea
- * E-mail:
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Abstract
Cardiac SPECT continues to play a critical role in detecting and managing cardiovascular disease, in particularly coronary artery disease (CAD) (Jaarsma et al 2012 J. Am. Coll. Cardiol. 59 1719-28), (Agostini et al 2016 Eur. J. Nucl. Med. Mol. Imaging 43 2423-32). While conventional dual-head SPECT scanners using parallel-hole collimators and scintillation crystals with photomultiplier tubes are still the workhorse of cardiac SPECT, they have the limitations of low photon sensitivity (~130 count s-1 MBq-1), poor image resolution (~15 mm) (Imbert et al 2012 J. Nucl. Med. 53 1897-903), relatively long acquisition time, inefficient use of the detector, high radiation dose, etc. Recently our field observed an exciting growth of new developments of dedicated cardiac scanners and collimators, as well as novel imaging algorithms for quantitative cardiac SPECT. These developments have opened doors to new applications with potential clinical impact, including ultra-low-dose imaging, absolute quantification of myocardial blood flow (MBF) and coronary flow reserve (CFR), multi-radionuclide imaging, and improved image quality as a result of attenuation, scatter, motion, and partial volume corrections (PVCs). In this article, we review the recent advances in cardiac SPECT instrumentation and imaging methods. This review mainly focuses on the most recent developments published since 2012 and points to the future of cardiac SPECT from an imaging physics perspective.
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Affiliation(s)
- Jing Wu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, United States of America
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Kim AS, Bergmann SR. Anthracycline-induced cardiomyopathy: The search continues. J Nucl Cardiol 2017; 24:265-267. [PMID: 26645603 DOI: 10.1007/s12350-015-0352-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Agnes S Kim
- Department of Medicine, The Pat and Jim Calhoun Cardiology Center, Farmington, CT, 06032, USA
| | - Steven R Bergmann
- Department of Medicine, The Pat and Jim Calhoun Cardiology Center, Farmington, CT, 06032, USA.
- Department of Diagnostic Imaging and Therapeutics, University of Connecticut School of Medicine, Farmington, CT, 06030, USA.
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Impact of concomitant medication use on myocardial 123I-mIBG imaging results in patients with heart failure. Nucl Med Commun 2017; 38:141-148. [DOI: 10.1097/mnm.0000000000000619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Sestini S, Pestelli F, Leoncini M, Bellandi F, Mazzeo C, Mansi L, Carrio I, Castagnoli A. The natural history of takotsubo syndrome: a two-year follow-up study with myocardial sympathetic and perfusion G-SPECT imaging. Eur J Nucl Med Mol Imaging 2016; 44:267-283. [PMID: 27909770 DOI: 10.1007/s00259-016-3575-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/18/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate changes in sympathetic activity, perfusion, and left ventricular (LV) functionality in takotsubo cardiomyopathy (TTC) patients from onset (T0) to post-onset conditions at 1 month (T1), 1-2 years (T2, T3). METHODS Twenty-two patients (70 ± 11 years) underwent serial gated single photon emission tomography (G-SPECT) studies with 123I-mIBG and 99mTc-Sestamibi. Statistics were performed using ANOVA/Sheffé post-hoc, correlation test, and receiver operating characteristic (ROC) curve analysis (p < 0.05). RESULTS Patients presented at T0 with LV ballooning and reduced early-late mIBG uptake (95%, 100%), left ventricular ejection fraction (LVEF)G-SPECT (86%) and perfusion (77 %). Adrenergic dysfunction was greater in apex, it overlaps with contractile impairment, and both were more severe than perfusion defect. During follow-up, LVEFG-SPECT, contractility, and perfusion were normal, while 82% and 90% of patients at T1 and 50% at T2 and T3 continued to show a reduced apical early-late mIBG distribution. These patients presented at T0-T1 with greater impairment of adrenergic function, contractility, and perfusion. A relationship was present within innervation and both perfusion and contractile parameters at T0 and T1, and between the extent of adrenergic defect at T3 and both the defect extent and age at T0 (cut-off point 42.5%, 72 years). CONCLUSION Outcome for TTC is not limited to a reversible contractile and perfusion abnormalities, but it includes residual adrenergic dysfunction, depending on the level of adrenergic impairment and age of patients at onset. The number of patients, as well as degree of perfusion abnormalities were found to be higher than those previously reported possibly depending on the time-interval between hospital admission and perfusion scan.
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Affiliation(s)
- Stelvio Sestini
- Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, N.O.P. - S. Stefano, U.S.L. Toscana Centro, via Suor Niccolina Infermiera 20, 59100, Prato, Italy.
| | - Francesco Pestelli
- Deptartment of Internal Medicine, Cardiovascular Unit, N.O.P. - S. Stefano, U.S.L, Toscana Centro, Prato, Italy
| | - Mario Leoncini
- Deptartment of Internal Medicine, Cardiovascular Unit, N.O.P. - S. Stefano, U.S.L, Toscana Centro, Prato, Italy
| | - Francesco Bellandi
- Deptartment of Internal Medicine, Cardiovascular Unit, N.O.P. - S. Stefano, U.S.L, Toscana Centro, Prato, Italy
| | - Christian Mazzeo
- Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, N.O.P. - S. Stefano, U.S.L. Toscana Centro, via Suor Niccolina Infermiera 20, 59100, Prato, Italy
| | - Luigi Mansi
- Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, University II Naples, Naples, Italy
| | - Ignasi Carrio
- Nuclear Medicine, Hospital Sant Pau, Barcelona, Spain
| | - Antonio Castagnoli
- Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, N.O.P. - S. Stefano, U.S.L. Toscana Centro, via Suor Niccolina Infermiera 20, 59100, Prato, Italy
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Suzuki T, Nazarian S, Jerosch-Herold M, Chugh SS. Imaging for assessment of sudden death risk: current role and future prospects. Europace 2016; 18:1491-1500. [PMID: 27098112 DOI: 10.1093/europace/euv456] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 12/28/2015] [Indexed: 12/18/2022] Open
Abstract
Sudden cardiac death (SCD) remains a major public health problem and there is an urgent need to maximize the impact of primary prevention using the implantable defibrillator. While implantable defibrillators are of utility for prevention of SCD, current methods of selecting candidates have significant shortcomings. Major advancements have occurred in the field of cardiac imaging, with significant potential to identify novel cardiac substrates for improved prediction. While assessment of the left ventricular ejection fraction remains the current major predictor, it is likely that several novel imaging markers will be incorporated into future risk stratification approaches. The goal of this review is to discuss the current status and future potential of cardiac imaging modalities to enhance risk stratification for SCD.
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Affiliation(s)
- Takeki Suzuki
- Division of Cardiology, Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Saman Nazarian
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sumeet S Chugh
- The Heart Institute, Advanced Health Sciences Pavilion Suite A3100, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Los Angeles, CA 90048, USA
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Enomoto M, Ishizu T, Seo Y, Kameda Y, Suzuki H, Shimano H, Kawakami Y, Aonuma K. Myocardial dysfunction identified by three-dimensional speckle tracking echocardiography in type 2 diabetes patients relates to complications of microangiopathy. J Cardiol 2016; 68:282-7. [PMID: 27146366 DOI: 10.1016/j.jjcc.2016.03.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The clinical effect of diabetic microangiopathy on left ventricular (LV) function is still uncertain. The purpose of this study was to assess the relation between diabetic microvascular complications and comprehensive myocardial deformation measurements using three-dimensional (3D) speckle tracking echocardiography. METHODS Seventy-seven asymptomatic patients with type 2 diabetes mellitus (DM) and 35 age-matched healthy control subjects underwent 3D echocardiography. Patients with coronary artery disease or LV ejection fraction <50% were excluded. Presence of proliferative retinopathy, microalbuminuria as nephropathy, and decreased coefficient of variation of R-R intervals (CVRR) <3% as cardiac autonomic neuropathy were defined as diabetic microvascular complications. RESULTS LV ejection fraction, LV mass index, and global radial strain did not differ between control and DM patients. However, global longitudinal and circumferential strain and endocardial area change ratio were lower in patients with DM than in the controls (-12.0±3.0% vs. -16.2±1.9%, -27.7±7.1% vs. 32.2±5.7%, -37.6±7.6% vs. 44.0±6.2%, respectively, p<0.001). In DM patients, longitudinal strain is related to CVRR (R=0.58, p<0.001), retinopathy stage, and nephropathy stage. CONCLUSIONS Diabetic microangiopathy and its accumulated effects significantly related to subclinical LV dysfunction are characterized by impaired longitudinal shortening.
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Affiliation(s)
- Mami Enomoto
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuri Kameda
- Department of Medical Sciences, University of Tsukuba, Tsukuba, Japan
| | - Hiroaki Suzuki
- Division of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Shimano
- Division of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Kawakami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Kasama S, Toyama T, Kurabayashi M. Usefulness of Cardiac Sympathetic Nerve Imaging Using 123Iodine-Metaiodobenzylguanidine Scintigraphy for Predicting Sudden Cardiac Death in Patients With Heart Failure. Int Heart J 2016; 57:140-4. [DOI: 10.1536/ihj.15-508] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shu Kasama
- Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine
| | - Takuji Toyama
- Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine
| | - Masahiko Kurabayashi
- Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine
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13
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Guimarães SLPDMM, Brandão SCS, Andrade LR, Maia RJC, Markman Filho B. Cardiac sympathetic hyperactivity after chemotherapy: early sign of cardiotoxicity? Arq Bras Cardiol 2015; 105:228-34. [PMID: 26176188 PMCID: PMC4592170 DOI: 10.5935/abc.20150075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 10/14/2014] [Accepted: 11/21/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Chemotherapy with anthracyclines and trastuzumab can cause cardiotoxicity. Alteration of cardiac adrenergic function assessed by metaiodobenzylguanidine labeled with iodine-123 (123I-mIBG) seems to precede the drop in left ventricular ejection fraction. OBJECTIVE To evaluate and to compare the presence of cardiovascular abnormalities among patients with breast cancer undergoing chemotherapy with anthracyclines and trastuzumab, and only with anthracycline. METHODS Patients with breast cancer were analyzed clinical, laboratory, electrocardiographic and echocardiographic and cardiac sympathetic activity. In scintigraphic images, the ratio of 123I-mIBG uptake between the heart and mediastinum, and the washout rate were calculated. The variables were compared between patients who received anthracyclines and trastuzumab (Group 1) and only anthracyclines (Group 2). RESULTS Twenty patients, with mean age 57 ± 14 years, were studied. The mean left ventricular ejection fraction by echocardiography was 67.8 ± 4.0%. Mean washout rate was 28.39 ± 9.23% and the ratio of 123I-mIBG uptake between the heart and mediastinum was 2.07 ± 0.28. Of the patients, 82% showed an increased in washout rate, and the ratio of 123I-mIBG uptake between the heart and mediastinum decreased in 25%. Concerning the groups, the mean washout rate of Group 1 was 32.68 ± 9.30% and of Group 2 was 24.56 ± 7.72% (p = 0,06). The ratio of 123I-mIBG uptake between the heart and mediastinum was normal in all patients in Group 2, however, the Group 1, showed 50% the ratio of 123I-mIBG uptake between the heart and mediastinum ≤ 1.8 (p = 0.02). CONCLUSION In women with breast cancer undergoing chemotherapy, assessment of cardiac sympathetic activity with 123I-mIBG appears to be an early marker of cardiotoxicity. The combination of chemotherapy showed higher risk of cardiac adrenergic hyperactivity.
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Affiliation(s)
| | | | | | - Rafael José Coelho Maia
- Pós-Graduação em Ciências da Saúde da Universidade Federal de
Pernambuco (PGCS-UFPE), Recife, PE – Brazil
- Hospital Agamenon Magalhães (HAM), Recife, PE – Brazil
| | - Brivaldo Markman Filho
- Pós-Graduação em Ciências da Saúde da Universidade Federal de
Pernambuco (PGCS-UFPE), Recife, PE – Brazil
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Barsanti C, Lenzarini F, Kusmic C. Diagnostic and prognostic utility of non-invasive imaging in diabetes management. World J Diabetes 2015; 6:792-806. [PMID: 26131322 PMCID: PMC4478576 DOI: 10.4239/wjd.v6.i6.792] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/23/2014] [Accepted: 04/14/2015] [Indexed: 02/05/2023] Open
Abstract
Medical imaging technologies are acquiring an increasing relevance to assist clinicians in diagnosis and to guide management and therapeutic treatment of patients, thanks to their non invasive and high resolution properties. Computed tomography, magnetic resonance imaging, and ultrasonography are the most used imaging modalities to provide detailed morphological reconstructions of tissues and organs. In addition, the use of contrast dyes or radionuclide-labeled tracers permits to get functional and quantitative information about tissue physiology and metabolism in normal and disease state. In recent years, the development of multimodal and hydrid imaging techniques is coming to be the new frontier of medical imaging for the possibility to overcome limitations of single modalities and to obtain physiological and pathophysiological measurements within an accurate anatomical framework. Moreover, the employment of molecular probes, such as ligands or antibodies, allows a selective in vivo targeting of biomolecules involved in specific cellular processes, so expanding the potentialities of imaging techniques for clinical and research applications. This review is aimed to give a survey of characteristics of main diagnostic non-invasive imaging techniques. Current clinical appliances and future perspectives of imaging in the diagnostic and prognostic assessment of diabetic complications affecting different organ systems will be particularly addressed.
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Borgquist R, Singh JP. An Electrophysiologist Perspective on Risk Stratification in Heart Failure: Can Better Understanding of the Condition of the Cardiac Sympathetic Nervous System Help? J Nucl Med 2015; 56 Suppl 4:59S-64S. [DOI: 10.2967/jnumed.114.148452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Yoshinaga K, Tomiyama Y, Manabe O, Kasai K, Katoh C, Magota K, Suzuki E, Nishijima KI, Kuge Y, Ito YM, Tamaki N. Prone-position acquisition of myocardial (123)I-metaiodobenzylguanidine (MIBG) SPECT reveals regional uptake similar to that found using (11)C-hydroxyephedrine PET/CT. Ann Nucl Med 2014; 28:761-9. [PMID: 24950751 DOI: 10.1007/s12149-014-0868-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 06/09/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES (123)I-metaiodobenzylguanidine (MIBG) has been used to estimate cardiac sympathetic nervous innervation. Heterogeneous MIBG distribution is mainly associated with high physiological MIBG uptakes in the liver. We postulate that prone position acquisition might be especially effective for MIBG, providing for separation from high liver uptake similar to that provided by perfusion single-photon emission computed tomography (SPECT). We investigated whether prone-position acquisition improved MIBG image quality by comparing our results to those acquired using supine MIBG and high-quality (11)C-hydroxyephedrine (HED) positron emission tomography/computed tomography PET/CT. METHODS Ten male volunteers (body mass index (BMI) 22.7 ± 3.4) underwent prone and supine MIBG and HED PET. Relative regional tracer uptake was estimated in early MIBG and HED. Acquired images were divided into 17 segments and were grouped into 4 regions: anterior, inferior, septum, and lateral. For each patient, the inferior/anterior ratio was calculated. RESULTS The quality of images acquired using prone MIBG was better than that using supine MIBG (p < 0.05). Inferior and septum relative MIBG uptake was reduced in comparison with anterior or lateral MIBG uptake in the supine position (inferior vs. anterior: 69.0 ± 5.6 vs. 82.3 ± 4.6 %, p < 0.01; septum vs. lateral: 66.2 ± 5.1 vs. 81.9 ± 5.4 %, p < 0.01). Prone MIBG showed a significantly higher inferior/anterior uptake ratio in comparison with supine MIBG (n = 24, seg: 92.2 ± 7.2 vs. 83.6 ± 5.7 %, p < 0.05). However, intergroup differences in uptake ratio were demonstrated among prone and supine MIBG and HED. HED PET/CT still showed a higher uptake ratio in comparison with prone MIBG SPECT (103.9 ± 8.0 vs. 92.2 ± 7.2 %, p < 0.05). CONCLUSION Even in normal male subjects, standard supine MIBG imaging showed reduced inferior and septum uptake. Uptake with prone MIBG imaging showed a significant improvement over that with supine imaging and was closer to uptake for HED PET/CT. This improvement may be the result of preventing intense uptake by the liver. Prone data acquisition may be a viable alternative in evaluating regional abnormalities using MIBG SPECT in men.
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Affiliation(s)
- Keiichiro Yoshinaga
- Department of Molecular Imaging, Hokkaido University Graduate School of Medicine, Kita15 Nishi7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan,
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Imaging of Cardiac Autonomic Innervation with SPECT and PET. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-013-9242-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Pulmonary vein isolation in patients with paroxysmal atrial fibrillation is associated with regional cardiac sympathetic denervation. EJNMMI Res 2013; 3:81. [PMID: 24360192 PMCID: PMC3892075 DOI: 10.1186/2191-219x-3-81] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Circumferential pulmonary vein isolation (PVI) is the cornerstone of the current state-of-the-art management of atrial fibrillation (AF). However, the precise mechanisms behind AF relapses post PVI are still unknown. Since the activity of the autonomous nervous system is crucial in triggering paroxysmal AF, we hypothesized that PVI is associated with changes of cardiac sympathetic activity. METHODS Sixteen patients with paroxysmal AF underwent cardiac iodine-123-meta-iodobenzylguanidine (123I-mIBG) planar cardiac imaging and single-photon emission computed tomography with low-dose computed tomography (SPECT/CT) for attenuation correction before and 4 weeks after PVI. The heart-to-mediastinum ratio (H/M ratio), washout rate (WR), regional myocardial uptake, and regional washout were analyzed. RESULTS The late H/M ratio was unchanged by PVI (pre, 2.9 ± 0.5 vs. post, 2.7 ± 0.6, p = 0.53). Four of the 16 patients (25%) displayed regional deficits before PVI. After PVI, regional deficits were present in ten patients (62.5%) with newly emerging deficits localized in the inferolateral wall. In a 6-month follow-up, four out of the ten patients (40%) with regional 123I-mIBG defects suffered from a recurrence of AF, while only one of the six patients (16.7%) without a regional 123I-mIBG defect experienced a recurrence. CONCLUSION A significant number of patients with paroxysmal AF show regional cardiac sympathetic innervation deficits at baseline. In addition, PVI is associated with newly emerging defects. The presence of regional sympathetic denervation after PVI may correlate with the risk of AF relapses.
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Reduced cardiac 123I-metaiodobenzylguanidine uptake in patients with spinocerebellar ataxia type 2: a comparative study with Parkinson's disease. Eur J Nucl Med Mol Imaging 2013; 40:1914-21. [PMID: 23929432 DOI: 10.1007/s00259-013-2524-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant neurodegenerative disorder characterized by cerebellar ataxia, supranuclear ophthalmoplegia, and peripheral neuropathy. Autonomic nervous system dysfunction is often present. This study evaluated the cardiac sympathetic function in patients with SCA2 using (123)I-metaiodobenzylguanidine (MIBG) in comparison with patients with Parkinson's disease (PD) and control subjects. METHODS Nine patients with SCA2, nine patients with PD, and nine control subjects underwent (123)I-MIBG imaging studies from which early and late heart-to-mediastinum (H/M) ratios and myocardial washout rates were calculated. RESULTS Early (F = 12.3, p < 0.0001) and late (F = 16.8, p < 0.0001) H/M ratios were significantly different among groups. In controls, early and late H/M ratios (2.2 ± 0.12 and 2.1 ± 0.20) were significantly higher than in patients with SCA2 (1.9 ± 0.23 and 1.8 ± 0.20, both p < 0.05) and with patients with PD (1.7 ± 0.29 and 1.4 ± 0.35, both p < 0.001). There was also a significant difference in washout rates among groups (F = 11.7, p < 0.0001). In controls the washout rate (19.9 ± 9.6%) was significantly lower (p < 0.005) than in patients with PD (51.0 ± 23.7%), but not different from that in SCA2 patients (19.5 ± 9.4%). In SCA2 patients, in a multivariable linear regression analysis only the Scale for the Assessment and Rating of Ataxia score was independently associated with early H/M ratio (β = -0.12, p < 0.05). CONCLUSION (123)I-MIBG myocardial scintigraphy demonstrated an impairment of cardiac sympathetic function in patients with SCA2, which was less marked than in PD patients. These results suggest that (123)I-MIBG cardiac imaging could become a useful tool for analysing the pathophysiology of SCA2.
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Martins da Silva MI, Vidigal Ferreira MJ, Morão Moreira AP. Iodine-123-metaiodobenzylguanidine scintigraphy in risk stratification of sudden death in heart failure. Rev Port Cardiol 2013; 32:509-16. [PMID: 23731734 DOI: 10.1016/j.repc.2012.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 11/01/2012] [Indexed: 01/08/2023] Open
Abstract
Metaiodobenzylguanidine (MIBG) is a false neurotransmitter noradrenaline analogue that is taken up by the 'uptake 1' transporter mechanism in the cell membrane of presynaptic adrenergic neurons and accumulates in catecholamine storage vesicles. Since it is practically unmetabolized, it can be labeled with a radioisotope (iodine-123) in scintigraphic exams to noninvasively assess the functional status of the sympathetic innervation of organs with a significant adrenergic component, including the heart. Studies of its application in nuclear cardiology appear to confirm its value in the assessment of conditions such as coronary artery disease, heart failure, arrhythmias and sudden death. Heart failure is a global problem, with an estimated prevalence of 2% in developed countries. Sudden cardiac death is the main cause of its high mortality. The autonomic nervous system dysfunction, including sympathetic hyperactivity, that accompanies chronic heart failure is associated with progressive myocardial remodeling, declining left ventricular function and worsening symptoms, and contributes to the development of ventricular arrhythmias and sudden death. Since 123I-MIBG cardiac scintigraphy can detect changes in the cardiac adrenergic system, there is considerable interest in its role in obtaining diagnostic and prognostic information in patients with heart failure. In this article we present a literature review on the use of 123I-MIBG scintigraphy for risk stratification of sudden death in patients with heart failure.
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Martins da Silva MI, Vidigal Ferreira MJ, Morão Moreira AP. Iodine-123-metaiodobenzylguanidine scintigraphy in risk stratification of sudden death in heart failure. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Radionuclide cardiac imaging has potential to assess underlying molecular, electrophysiologic, and pathophysiologic processes of cardiac disease. An area of current interest is cardiac autonomic innervation imaging with a radiotracer such as (123)I-meta-iodobenzylguanidine ((123)I-mIBG), a norepinephrine analogue. Cardiac (123)I-mIBG uptake can be assessed by planar and SPECT techniques, involving determination of global uptake by a heart-to-mediastinal ratio, tracer washout between early and delayed images, and focal defects on tomographic images. Cardiac (123)I-mIBG findings have consistently been shown to correlate strongly with heart failure severity, pre-disposition to cardiac arrhythmias, and poor prognosis independent of conventional clinical, laboratory, and image parameters. (123)I-mIBG imaging promises to help monitor a patient's clinical course and response to therapy, showing potential to help select patients for an ICD and other advanced therapies better than current methods. Autonomic imaging also appears to help diagnose ischemic heart disease and identify higher risk, as well as risk-stratify patients with diabetes. Although more investigations in larger populations are needed to strengthen prior findings and influence modifications of clinical guidelines, cardiac (123)I-mIBG imaging shows promise as an emerging technique for recognizing and following potentially life-threatening conditions, as well as improving our understanding of the pathophysiology of various diseases.
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Affiliation(s)
- Mark I Travin
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East-210th Street, Bronx, NY 10467-2490, USA.
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Sacre JW, Franjic B, Coombes JS, Marwick TH, Baumert M. QT interval variability in type 2 diabetic patients with cardiac sympathetic dysinnervation assessed by 123I-metaiodobenzylguanidine scintigraphy. J Cardiovasc Electrophysiol 2012; 24:305-13. [PMID: 23210722 DOI: 10.1111/jce.12039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
UNLABELLED QT Variability and Sympathetic Dysinnervation. INTRODUCTION The mechanism of adverse prognosis attributable to proarrhythmic cardiac sympathetic dysinnervation in patients with type 2 diabetes is incompletely understood. This study sought the association of cardiac sympathetic dysinnervation with temporal instability of ventricular repolarization assessed by beat-to-beat QT interval variability. METHODS AND RESULTS (123) I-metaiodobenzylguanidine ((123) I-MIBG) scintigraphy was analyzed in 31 type 2 diabetic patients for cardiac sympathetic dysinnervation (4-hour heart-to-mediastinum ratio <1.8) and regional sympathetic integrity and washout rate (from 15-minute (123) I-MIBG uptake). Relative QT variability was defined from a continuous 5-minute ECG in the supine position (n = 31) and standing position (subgroup; n = 15) by the log ratio of absolute QT variability (QT variance divided by the mean QT interval squared) to heart rate (HR) variability (HR variance divided by the mean HR squared). Patients with (n = 16; 52%) versus without cardiac sympathetic dysinnervation demonstrated higher relative QT variability in the supine position (P < 0.001), owing to lower HR variability. However, on standing, absolute QT variability was significantly raised in these patients (P = 0.009) despite similar HR variability in the 2 groups. Correlations of heart-to-mediastinum ratio with standing QT variability (relative [r =-0.63, P = 0.013] and absolute [r =-0.79, P = 0.001]) were superior to corresponding supine measures (relative [r =-0.47, P = 0.008] and absolute [P = NS]). No associations of QT variability with washout rate or regional (123) I-MIBG uptake were identified. CONCLUSION Elevated QT variability is associated with cardiac sympathetic dysinnervation in type 2 diabetes and may contribute to adverse prognosis. Moreover, QT variability may be more specific for cardiac sympathetic innervation when measured in the context of sympathetic activation. (J Cardiovasc Electrophysiol, Vol. 24, pp. 305-313, March 2013).
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Affiliation(s)
- Julian W Sacre
- School of Medicine, The University of Queensland, Brisbane, Australia.
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24
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Arora R. Recent insights into the role of the autonomic nervous system in the creation of substrate for atrial fibrillation: implications for therapies targeting the atrial autonomic nervous system. Circ Arrhythm Electrophysiol 2012; 5:850-9. [PMID: 22895601 DOI: 10.1161/circep.112.972273] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rishi Arora
- Northwestern Memorial Hospital, Chicago, IL 60611, USA.
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25
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Travin MI, Kamalakkannan G. A key role for nuclear cardiac imaging in evaluating and managing patients with heart failure. J Nucl Cardiol 2012; 19:879-82. [PMID: 22918707 DOI: 10.1007/s12350-012-9615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tank J, Heusser K, Malehsa D, Hegemann K, Haufe S, Brinkmann J, Tegtbur U, Diedrich A, Bara C, Jordan J, Strüber M. Patients With Continuous-Flow Left Ventricular Assist Devices Provide Insight in Human Baroreflex Physiology. Hypertension 2012; 60:849-55. [DOI: 10.1161/hypertensionaha.112.198630] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jens Tank
- From the Institute of Clinical Pharmacology (J.T., K.Heu., K.Heg., S.H., J.B., J.J.), Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery (D.M., C.B., M.S.), and Institute of Sports Medicine (S.H., U.T.), Hannover Medical School, Hannover, Germany; Division of Clinical Pharmacology (A.D.), Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Karsten Heusser
- From the Institute of Clinical Pharmacology (J.T., K.Heu., K.Heg., S.H., J.B., J.J.), Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery (D.M., C.B., M.S.), and Institute of Sports Medicine (S.H., U.T.), Hannover Medical School, Hannover, Germany; Division of Clinical Pharmacology (A.D.), Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Doris Malehsa
- From the Institute of Clinical Pharmacology (J.T., K.Heu., K.Heg., S.H., J.B., J.J.), Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery (D.M., C.B., M.S.), and Institute of Sports Medicine (S.H., U.T.), Hannover Medical School, Hannover, Germany; Division of Clinical Pharmacology (A.D.), Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Katrin Hegemann
- From the Institute of Clinical Pharmacology (J.T., K.Heu., K.Heg., S.H., J.B., J.J.), Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery (D.M., C.B., M.S.), and Institute of Sports Medicine (S.H., U.T.), Hannover Medical School, Hannover, Germany; Division of Clinical Pharmacology (A.D.), Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Sven Haufe
- From the Institute of Clinical Pharmacology (J.T., K.Heu., K.Heg., S.H., J.B., J.J.), Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery (D.M., C.B., M.S.), and Institute of Sports Medicine (S.H., U.T.), Hannover Medical School, Hannover, Germany; Division of Clinical Pharmacology (A.D.), Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Julia Brinkmann
- From the Institute of Clinical Pharmacology (J.T., K.Heu., K.Heg., S.H., J.B., J.J.), Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery (D.M., C.B., M.S.), and Institute of Sports Medicine (S.H., U.T.), Hannover Medical School, Hannover, Germany; Division of Clinical Pharmacology (A.D.), Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Uwe Tegtbur
- From the Institute of Clinical Pharmacology (J.T., K.Heu., K.Heg., S.H., J.B., J.J.), Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery (D.M., C.B., M.S.), and Institute of Sports Medicine (S.H., U.T.), Hannover Medical School, Hannover, Germany; Division of Clinical Pharmacology (A.D.), Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - André Diedrich
- From the Institute of Clinical Pharmacology (J.T., K.Heu., K.Heg., S.H., J.B., J.J.), Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery (D.M., C.B., M.S.), and Institute of Sports Medicine (S.H., U.T.), Hannover Medical School, Hannover, Germany; Division of Clinical Pharmacology (A.D.), Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Christoph Bara
- From the Institute of Clinical Pharmacology (J.T., K.Heu., K.Heg., S.H., J.B., J.J.), Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery (D.M., C.B., M.S.), and Institute of Sports Medicine (S.H., U.T.), Hannover Medical School, Hannover, Germany; Division of Clinical Pharmacology (A.D.), Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Jens Jordan
- From the Institute of Clinical Pharmacology (J.T., K.Heu., K.Heg., S.H., J.B., J.J.), Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery (D.M., C.B., M.S.), and Institute of Sports Medicine (S.H., U.T.), Hannover Medical School, Hannover, Germany; Division of Clinical Pharmacology (A.D.), Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Martin Strüber
- From the Institute of Clinical Pharmacology (J.T., K.Heu., K.Heg., S.H., J.B., J.J.), Department of Cardiac, Thoracic, Transplantation, and Vascular Surgery (D.M., C.B., M.S.), and Institute of Sports Medicine (S.H., U.T.), Hannover Medical School, Hannover, Germany; Division of Clinical Pharmacology (A.D.), Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
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van der Veen BJ, Al Younis I, de Roos A, Stokkel MPM. Assessment of global cardiac I-123 MIBG uptake and washout using volumetric quantification of SPECT acquisitions. J Nucl Cardiol 2012; 19:752-62. [PMID: 22669736 PMCID: PMC3395351 DOI: 10.1007/s12350-012-9539-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 02/18/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Assessment of cardiac innervation using single-photon emission computer tomography (SPECT) is less established than planar imaging, but may be more suitable for quantification. Therefore, a volumetric quantification of I-123 MIBG SPECT acquisitions was performed. Reproducibility, the effects of extra cardiac I-123 MIBG uptake and the relation with conventional planar indices were evaluated. METHODS 54 patients referred for planar and SPECT I-123 MIBG acquisitions were included. Ellipsoidal or box-shaped volumes of interest were placed on the left ventricle, cardiac lumen, mediastinum, lung and liver. SPECT segmentation was performed twice in all patients. Indices were determined based on the heart-to-mediastinum (HM), myocardial wall-to-mediastinum and myocardial wall-to-lumen regions. HM ratios and washout rates were also determined based on anterior planar images. RESULTS Cardiac count densities were highly reproducible (CV 1.5-5.4, ICC 0.96-0.99) and inter-rater variability was low (CV 1.8-6.8, ICC 0.94-0.99). Mediastinal uptake was an important explanatory variable of uptake in the entire heart (early R(2) = 0.36; delayed R(2) =0.43) and myocardial wall (early R(2) = 0.28; delayed R(2) = 0.37). Lung washout was an explanatory variable of organ washout of the heart (heart R(2) = 0.38; myocardial wall R(2) = 0.33). In general, SPECT indices showed moderate-to-good correlations with the planar uptake (PCC 0.497-0.851). CONCLUSION By applying a volumetric segmentation method we were able to segment the heart in all patients. SPECT I-123 MIBG quantification was found to be highly reproducible and had a moderate to good correlation with the planar indices.
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Affiliation(s)
- Berlinda J van der Veen
- Department of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Abstract
This article discusses currently available radionuclide techniques in the diagnostic and prognostic evaluation of patients with chronic heart failure, with a focus on stage B/asymptomatic left ventricular dysfunction. Radionuclide imaging is promising for such patients because it can simultaneously determine left ventricular function, evaluate for the presence of obstructive coronary disease, determine the extent of viable myocardium, and evaluate dyssynchronous left ventricular contraction. Radionuclide imaging can thus provide important noninvasive insights into the pathophysiology, prognosis, and management of patients with asymptomatic left ventricular dysfunction as well as more advanced heat failure.
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Affiliation(s)
- Rajesh Janardhanan
- Division of Cardiology, University of Virginia Health System, Charlottesville, VA 22908, USA
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Abstract
Cardiac autonomic innervation plays a key role in maintaining hemodynamic and electrophysiologic harmony. Cardiac sympathetic function is adversely altered in many disease states, such as congestive heart failure, myocardial ischemia, and diabetes. (123)I-mIBG, a sympathetic neurotransmitter radionuclide analog, aids in the detection of sympathetic innervation abnormalities and can be imaged with planar and single-photon emission computed tomographic techniques. Cardiac (123)I-mIBG uptake can be assessed by the heart mediastinal ratio (H/M), tracer washout rate, and focal uptake defects. These parameters have been widely studied and shown to correlate strongly and independently with congestive heart failure progression, cardiac arrhythmias, cardiac death, and all-cause mortality. There is accumulating evidence that (123)I-mIBG imaging can help to monitor a patient's clinical course and response to therapy. The ability to predict potentially lethal ventricular arrhythmias promises to help more accurately select patients for implantable cardioverter defibrillators, limiting unnecessary devices and identifying additional patients at risk who do not meet current guidelines. (123)I-mIBG shows potential to help determine whether greater risk and usually more expensive ventricular assist device therapies or cardiac transplantation might be needed. Although more investigation in larger populations is needed to strengthen previous findings, cardiac (123)I-mIBG imaging shows promise as a new technique for recognizing and following potentially life-threatening cardiac conditions.
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Affiliation(s)
- Amala Chirumamilla
- Department of Nuclear Medicine and Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Patel V, Papineni RVL, Gupta S, Stoyanova R, Ahmed MM. A realistic utilization of nanotechnology in molecular imaging and targeted radiotherapy of solid tumors. Radiat Res 2012; 177:483-95. [PMID: 22404738 DOI: 10.1667/rr2597.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Precise dose delivery to malignant tissue in radiotherapy is of paramount importance for treatment efficacy while minimizing morbidity of surrounding normal tissues. Current conventional imaging techniques, such as magnetic resonance imaging (MRI) and computerized tomography (CT), are used to define the three-dimensional shape and volume of the tumor for radiation therapy. In many cases, these radiographic imaging (RI) techniques are ambiguous or provide limited information with regard to tumor margins and histopathology. Molecular imaging (MI) modalities, such as positron emission tomography (PET) and single photon-emission computed-tomography (SPECT) that can characterize tumor tissue, are rapidly becoming routine in radiation therapy. However, their inherent low spatial resolution impedes tumor delineation for the purposes of radiation treatment planning. This review will focus on applications of nanotechnology to synergize imaging modalities in order to accurately highlight, as well as subsequently target, tumor cells. Furthermore, using such nano-agents for imaging, simultaneous coupling of novel therapeutics including radiosensitizers can be delivered specifically to the tumor to maximize tumor cell killing while sparing normal tissue.
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Affiliation(s)
- Vivek Patel
- Department of Radiation Oncology, University of Miami, Miami, Florida 33136, USA
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Kelesidis I, Travin MI. Use of cardiac radionuclide imaging to identify patients at risk for arrhythmic sudden cardiac death. J Nucl Cardiol 2012; 19:142-52; quiz 153-7. [PMID: 22130965 DOI: 10.1007/s12350-011-9482-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Sudden cardiac death (SCD) accounts for about ½ of all cardiovascular deaths, in most cases the result of a lethal ventricular arrhythmia. Patients considered at risk are often treated with an implantable cardiac defibrillator (ICD), but current criteria for device use, based largely on left ventricular ejection fraction (LVEF), leads to many patients receiving ICDs that they do not use, and many others not receiving ICDs but who suffer SCD. Thus, better methods of identifying patients at risk for SCD are needed, and radionuclide imaging offers much potential. Recent work has focused on imaging of cardiac autonomic innervation. (123)I-mIBG, a norepinephrine analog, is the tracer most studied, and a variety of positron emission tomographic tracers are also under investigation. Radionuclide autonomic imaging may identify at-risk patients with ischemic coronary artery disease, particularly following myocardial infarction and in the setting of hibernating myocardium. Most studies have been done in the setting of congestive heart failure (CHF), with a recent large multicenter study of patients with advanced disease, typically at high risk of SCD, showing that (123)I-mIBG can identify a low risk subgroup with an extremely low incidence of lethal ventricular arrhythmias and cardiac death, therefore, perhaps not requiring an ICD. Cardiac neuronal imaging has been shown to be better predictive of lethal arrhythmias/cardiac death than LVEF and New York Heart Association class, as well as various ECG parameters. Autonomic imaging will likely play an important role in the advancement of cardiac molecular imaging.
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Affiliation(s)
- Iosif Kelesidis
- Department of Nuclear Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East-210th Street, Bronx, NY 10467-2490, USA
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Fonseca VR, Freitas C, Palmeira M, Ferreira C, Victorino R. Cardiac Noradrenergic Denervation in a Patient with Multiple Symmetric Lipomatosis. Cardiology 2012; 121:160-3. [DOI: 10.1159/000336951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 01/23/2012] [Indexed: 12/12/2022]
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Graham MM. Clinical molecular imaging with radiotracers: current status. Med Princ Pract 2012; 21:197-208. [PMID: 22142905 DOI: 10.1159/000333552] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 09/05/2011] [Indexed: 12/17/2022] Open
Abstract
Molecular imaging is defined as the visualization, characterization, and measurement of biological processes at the molecular and cellular levels in humans and other living systems. Most clinical molecular imaging is currently done using radioisotope-labeled agents to define the activity of various metabolic pathways in vivo or to determine the distribution and density of various receptors relevant to human disease. This paper briefly reviews most of the commonly used radiopharmaceuticals in nuclear medicine, as well as newer agents that are likely to become available in the near future. The metabolic pathways include those relevant to the thyroid, parathyroid, heart, brain, bones, kidneys, liver, pancreas, adrenals and tumor. The receptor systems include agents useful in evaluating movement disorders, dementia, cardiac sympathetic enervation and neoangiogenesis. Receptor systems relevant to tumors include somatostatin receptors (neuroendocrine tumors), prostate-specific membrane antigen, carbonic anhydrase IX (renal cancer), and CD-20 (lymphoma). These agents, and newer agents that are being developed, are likely to become critical in the development of personalized medicine, where it will become increasingly important to determine whether a treatment that is targeted to a specific metabolic pathway or receptor is likely to be successful.
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Affiliation(s)
- Michael M Graham
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA.
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False heart-to-mediastinum ratio of I-123 metaiodobenzylguanidine due to right ventricular attenuation. Clin Nucl Med 2011; 36:828-30. [PMID: 21825865 DOI: 10.1097/rlu.0b013e31821c9d7b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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