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European Heart Journal 1994 15(Supplement D):14-19; doi:10.1093/eurheartj/15.suppl_D.14
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Metabolic Tissue Characterization in the Failing Heart by Positron Emission Tomography

M. Schwaiger, R. Beanlands and J. Vom Dahl

Division of Nuclear Medicine, University of Michigan, U.S.A., and Klinik und Poliklinik für Nuklearmedizin, Technische Universität München Germany

Correspondence: Prof. Markus Schwaiger. Nuklearmcdizinische Klinik und Poliklinik, der Technischen Universität München, Klinikum rechts der Isar, Ismaninger Str. 22.81675 München, Germany

Congestive heart failure represents an important clinical issue which can benefit from newer imaging approaches. Use of radiolabelled Pharmaceuticals allow for functional tissue characterization in patients with impaired left ventricular function. Assessment of regional myocardial perfusion and metabolism with either SPECT or PET methods provide accurate detection of tissue viability. Several studies have indicated the utility of these imaging approaches for improved selection of patients for revascularization. The combination of functional measurements with echocardiography and metabolic tissue characterization with PET allows for the non-invasive measurement of cardiac efficiency. The effect of various therapeutic interventions can be objectively assessed by a work-metabolic index. Finally, autonomic innervation of the heart plays an important role in the modulation of the haemodynamic performance of the failing heart. New imaging approaches using radiolabelled catecholamine analogues or receptor antagonists have been used to identify the integrity of myocardic pre- and post-synaptic sympathetic innervation. Imaging results in patients with dilated cardiomyopathy not only demonstrated a down-regulation of β-receptor density, but also an abnormal pre-synaptic neuronal function, which may result into impaired regulation of extraneuronal catecholamine concentration.

Thus, advanced scintigraphic imaging approaches may improve our diagnostic and prognostic workup in patients with congestive heart failure and may provide objective endpoints for the assessment of therapy.

Key Words: Positron emission tomography (PET) • coronary artery disease • revascularization • sympathetic innervation • C-11 hydroxyephedrine


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