Author + information
- Jason G.E. Zelt, MSca,b,
- Robert A. deKemp, PhDa,
- Benjamin H. Rotstein, PhDc,
- Girish M. Nair, MBBS, MScd,
- Jagat Narula, MD, PhDe,
- Ali Ahmadi, MD, PhDa,
- Rob S. Beanlands, MDa,b and
- Lisa M. Mielniczuk, MD, MSca,b,∗ ()
- aMolecular Function and Imaging Program, The National Cardiac PET Centre, Division of Cardiology, Department of Medicine and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Canada
- bDepartment of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- cDepartment of Biochemistry Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- dCardiac Electrophysiologist, Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
- eZena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Lisa M. Mielniczuk, Division of Cardiology, Department of Medicine and the Cardiac Research Methods Centre, University of Ottawa Heart Institute and University of Ottawa, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
• SNS dysfunction has been implicated in various cardiac diseases including heart failure, ischemic cardiomyopathy, and sudden cardiac death.
• Radiotracers for nuclear imaging have been developed to characterize the cardiac SNS.
• A composite knowledge of neuronal biology, radiotracer kinetics, and the disease pathology is critical to interpret SNS imaging.
• SNS imaging has clinical application in risk assessment, treatment monitoring, and tailoring treatment strategies across many CVD states.
• Larger prospective and randomized control trials are required to confirm whether SNS imaging strategies can guide clinical management that can impact outcomes.
Abnormalities in the cardiac sympathetic nervous system have been documented in various heart diseases and have been directly implicated in their pathogenesis and disease progression. Noninvasive techniques using single-photon-emitting radiotracers for planar scintigraphy and single-photon emission computed tomography, and positron-emitting tracers for positron emissions tomography, have been used to characterize the cardiac sympathetic nervous system with norepinephrine analogs [123I]meta-iodobenzylguanidine for planar and single-photon emission computed tomography imaging and [11C]meta-hydroxyephedrine for positron emissions tomography. Their usefulness in prognostication and risk stratification for cardiac events has been demonstrated. This review bridges basic and clinical research and focuses on applying an understanding of tracer kinetics and neuronal biology, to aid in the interpretation of nuclear imaging of cardiac sympathetic innervation.
Mr. Zelt is an MD/PhD student supported in part by the Vanier Canada Graduate Scholarship, The University of Ottawa, and by a government/industry grant from the Ontario Research Fund (ORF RE07-021; industry partners Lantheus Medical Imaging and Jubilant DraxImage). Dr. Ahmadi is supported by the University of Ottawa Cardiac Endowment Fund at the University of Ottawa Heart Institute. Dr. Beanlands is a Career Investigator supported by the Heart and Stroke Foundation of Ontario, a Tier 1 Chair in Cardiac Imaging Research at the University of Ottawa; and Vered Chair in Cardiology at the University of Ottawa Heart Institute. Dr. Mielniczuk is a Mid-career Clinician Scientist supported by Heart and Stroke Foundation of Ontario and Tier 2 Chair in HF Research at the University of Ottawa. This work was supported in part by a grant the Heart and Stroke Foundation of Canada (G-17-0018315). Dr. deKemp is a consultant for and has received grant funding from Lantheus Medical Imaging and Jubilant DraxImage; and has received revenues from Rubidium-82 generator technology licensed to Jubilant DraxImage and from sales of FlowQuant software. Dr. Beanlands is or has been a consultant for and has received grant funding from GE Healthcare, Lantheus Medical Imaging, and Jubilant DraxImage. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 7, 2018.
- Revision received January 20, 2019.
- Accepted January 22, 2019.
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.