Recent Advances of Nuclear Cardiology in Heart Failure

Nuclear cardiology tests play a pivotal role in the assessment and management of the patients with heart failure. Non-invasive insights into pathophysiology, prognosis can be obtained by quantitative gated single positron emission computed tomography (QGS). 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 left ventricular ejection fraction is readily identified by nuclear cardiology techniques. Newer techniques such as three-dimensional, wall thickening and cardiac dyssynchrony evaluation aid its assessment. Myocardial perfusion imaging, including phase analysis is also used to identify candidates for implantable cardiac defibrillator and cardiac resynchronization therapies. Neurotransmitter imaging using 123I-metaiodobenzylguanidine offers prognostic information in patients with heart failure. By adding MIBG heart-to-mediastinum ratio to BNP, ROC curve AUC significantly increased from 0.756 to 0.779 in our prognostic study of patients with heart failure. MIBG HMR was usefull for risk stratification. Cardiac metabolic imaging using 123I-BMIPP 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.