Imaging of myocardial autonomic innervation in patients with congestive heart failure: Methods and clinical implications

Abstract

The pathophysiologic role of the autonomic nervous system in the development of heart failure was recently recognized. Noninvasive imaging of cardiac autonomic innervatiou has become available for routine clinical diagnostic using SPECT in combination with 123]. metaiodobenzylguanidine. Positron emission tomography represents an alternative imaging modality with superior spatial resolution, allowing for sophisticated tracer approaches to various presynaptic and postsynaptic binding sites but is limited however, to few academic centers. The present review addresses the experimental and clinical experience with neuronal imaging in congestive heart failure. The clinical implications of these imaging findings are discussed. Present developments and future directions concerning the clinical application of available tracers, as well as the evaluation of new radiolabeled compounds for different sites of the autonomic nervous system and their significance for heart failure research, are presented.

The Old but Reliable Digitalis: Persistent Concerns and Expanded Indications

“…Norepinephrine measured directly by 123 I-MIBG can be attenuated by amiodarone or digoxin. 55 .s 6 Digitalis can increase vagal tone and reduce the bad effects of circadian rhythm.4.s 7 In the DIG study, suspected digitalis toxicity was 11.9% versus 7 .9% in the digoxin and placebo groups, respectively. The proportion actually hospitalised for digitalis toxicity in 3.5 years was low (2% vs 0.9%).…”

“…Norepinephrine measured directly by 123 I‐MIBG can be attenuated by amiodarone or digoxin 55,56 . Digitalis can increase vagal tone and reduce the bad effects of circadian rhythm 4,57 .…”