Published online Feb 26, 2014. doi: 10.13105/wjma.v2.i1.1
Revised: November 20, 2013
Accepted: December 17, 2013
Published online: February 26, 2014
Processing time: 123 Days and 19.6 Hours
Heart failure is a dynamic condition with high morbidity and mortality and its prognosis should be reassessed frequently, particularly in patients for whom critical treatment decisions may depend on the results of prognostication. In patients with heart failure, nuclear cardiology techniques are useful to establish the etiology and the severity of the disease, while fewer studies have explored the potential capability of nuclear cardiology to guide cardiac resynchronization therapy (CRT) and to select patients for implantable cardioverter defibrillators (ICD). Left ventricular synchrony may be assessed by radionuclide angiography or gated single-photon emission computed tomography myocardial perfusion scintigraphy. These modalities have shown promise as predictors of CRT outcome using phase analysis. Combined assessment of myocardial viability and left ventricular dyssynchrony is feasible using positron emission tomography and could improve conventional response prediction criteria for CRT. Preliminary data also exists on integrated positron emission tomography/computed tomography approach for assessing myocardial viability, identifying the location of biventricular pacemaker leads, and obtaining left ventricular functional data, including contractile phase analysis. Finally, cardiac imaging with autonomic radiotracers may be useful in predicting CRT response and for identifying patients at risk for sudden cardiac death, therefore potentially offering a way to select patients for both CRT and ICD therapy. Prospective trials where imaging is combined with image-test driven therapy are needed to better define the role of nuclear cardiology for guiding device therapy in patients with heart failure.
Core tip: This article focuses on the potential capability of nuclear cardiology techniques to guide cardiac resynchronization therapy and to select patients for implantable cardioverter defibrillators. Radionuclide angiography and gated single-photon emission computed tomography myocardial perfusion imaging have shown promise as predictors of outcome after device therapies. Combined positron emission tomography/computed tomography may identify the location of biventricular pacemaker leads and obtain left ventricular functional data, including contractile phase analysis. Cardiac imaging with autonomic radiotracers may predict cardiac resynchronization therapy response and may also identify patients at risk for sudden cardiac death, therefore potentially offering a way to select patients for these device treatments.