Congestive heart failure is a very serious disease that affects many people.
Increased sympathetic tone, noradrenaline release, decreased neuronal noradrenaline
transporter function and noradrenaline concentration are present in the failing heart. An
impairment of sympathetic and parasympathetic function increases the risk of mortality
in patients with heart disease. Non invasive imaging modalities are used to evaluate
heart failure patients like echocardiography, magnetic resonance imaging and
radioisotopique techniques. Single photon emission computed tomography (SPECT)
and positron emission tomography (PET) are now used for the assessment of the
cardiac sympathetic and parasympathetic function. SPECT imaging with 123I
metaiodobenzylguanidine is a very useful modality for patients with abnormal cardiac
sympathetic function but its role in the quantitative assessment of myocardial
autonomic nervous system is limited due to the relative low spatial resolution. PET, the
new functional imaging modality, offers more detailed information about the biology of
the heart failure helping to the accurate detection, and monitoring of dedicated
therapeutic procedures. Another advantage of PET is that multiple tracers may be used
providing deeper insights into nerve biology, such as tracers of sympathetic neuronal
integrity [11C-hydroxyephedrine (11C-HED), 11C-epinephrine (11C-EPI), 11C-phenyl-
-phrine (11C-PHE) etc.], tracers of adrenergic receptors (11C-CGP12177, 11C-CGP
12388, 11C-GB 67), and tracers of parasympathetic integrity (vesamicol derivatives
etc.). PET can assess the sympathetic innervation and activation of the heart. Therefore,
clinical applications in heart failure patients include risk stratification, assessment of
ventricular arrhythmias and of risk of sudden cardiac death, identification of patients
who should undergo implantation of defibrillators and therapy assessment.
Keywords: 11C-CGP12177, 11C-CGP12388, 11C-epinephrine, 11C-GB 67, 11Chydroxyephedrine,
11C-phenylephrine, Heart failure, Implantable cardioverter
defibrillator, Neurotransmission imaging, Positron emission tomography, Sudden cardiac
death, Vesamicol derivatives.