Clinical use of nuclear cardiology in the assessment of heart failure

Shinro Matsuo, Kenichi Nakajima, Seigo Kinuya, Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Ishikawa, Japan.
World Journal of Cardiology (WJC) (Impact Factor: 2.06). 10/2010; 2(10):344-56. DOI: 10.4330/wjc.v2.i10.344
Source: PubMed


A nuclear cardiology test is the most commonly performed non-invasive cardiac imaging test in patients with heart failure, and it plays a pivotal role in their assessment and management. Quantitative gated single positron emission computed tomography (QGS) is used to assess quantitatively cardiac volume, left ventricular ejection fraction (LVEF), stroke volume, and cardiac diastolic function. Resting and stress myocardial perfusion imaging, with exercise or pharmacologic stress, plays a fundamental role in distinguishing ischemic from non-ischemic etiology of heart failure, and in demonstrating myocardial viability. Diastolic heart failure also termed as heart failure with a preserved LVEF is readily identified by nuclear cardiology techniques and can accurately be estimated by peak filling rate (PFR) and time to PFR. Movement of the left ventricle can also be readily assessed by QGS, with newer techniques such as three-dimensional, wall thickening evaluation aiding its assessment. Myocardial perfusion imaging is also commonly used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Neurotransmitter imaging using (123)I-metaiodobenzylguanidine offers prognostic information in patients with heart failure. Metabolism and function in the heart are closely related, and energy substrate metabolism is a potential target of medical therapies to improve cardiac function in patients with heart failure. Cardiac metabolic imaging using (123)I-15-(p-iodophenyl)3-R, S-methylpentadecacoic acid is a commonly used tracer in clinical studies to diagnose metabolic heart failure. Nuclear cardiology tests, including neurotransmitter imaging and metabolic imaging, are now easily preformed with new tracers to refine heart failure diagnosis. Nuclear cardiology studies contribute significantly to guiding management decisions for identifying cardiac risk in patients with heart failure.

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Available from: Seigo Kinuya, Apr 14, 2014
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    ABSTRACT: Objective: To investigate clinical usefulness of a novel program "Heart Function View (HFV)" for evaluating left ventricular (LV) function from myocardial perfusion SPECT (MPS), we compared LV functional parameters (F(x)) calculated by HFV with those obtained by the other similar programs QGS and cardioGRAF or by ultrasound echocardiography (UCG) and examined their correlations with clinical markers of heart failure: plasma BNP concentrations (BNPs) and exercise capacity. Methods: Studied patients (n = 60) underwent technetium-99m tetrofosmin quantitative gated MPS including treadmill exercise for examining heart disease. Myocardial stress images were acquired 30 min after the first tracer injection during maximal exercise. Three hours later, the second tracer was injected, and resting images were acquired. LV systolic F(x) [ejection fraction (EF), peak ejection rate (PER)] and diastolic F(x) [first third filling fraction (1/3FF), first third filling rate (1/3FR), peak filling rate (PFR), time to PFR (TPF)] were analyzed, and phase standard deviation (SD) and histogram bandwidth were obtained by phase analysis. Results: LV end-diastolic volume (EDV), end-systolic volume (ESV) and EF obtained from HFV were well correlated with those from QGS, cardioGRAF and UCG. A diastolic parameter Doppler E/e' from UCG was significantly with PFR from HFV. There were good correlations between LVEDV, LVESV, LVEF, PER, PFR, 1/3FR, TPF and 1/3FF from HFV and those from cardioGRAF. LVEF, PER, 1/3FR, and PFR were significantly correlated with plasma BNP concentrations. In patients with non-ischemic heart disease (n = 42), phase SD and histogram bandwidth were correlated negatively with exercise capacity or PFR. Conclusions: HFV-derived LVF(x) are correlated with LVF(x) from the other programs or UCG, or with the clinical markers of heart failure and are thus useful in the functional assessment for patients with heart disease.
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