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proLékaře.cz / Journals / Nuclear Medicine / 2020 - 3

Role of scintigraphic procedures in patients with heart failure and preserved ejection fraction

Czech version

Authors: Otto Lang
Authors‘ workplace: Oddělení nukleární medicíny, Oblastní nemocnice Příbram, a. s. ;  Oddělení nukleární medicíny, PMCD s. r. o., Praha 6, ČR ;  Klinika nukleární medicíny, 3. LF UK a FN Královské Vinohrady, Praha 10
Published in: NuklMed 2020;9:49-58
Category: Review Article

Overview

Introduction: Heart failure with preserved ejection fraction (HFpEF) is responsible for approximately half of all heart failure cases and its frequency is still growing. Pathophysiological changes are very complex. They include maladaptation, remodeling and hypertrophy, apoptosis, death and regeneration of myocardial muscle cells. Functional impairment can be of different origin, there is usually a combination of different causes. Ischemia, metabolic disorders, sympathetic system impairment and some others (inflammation, restrictive cardiomypathy) are the most significant.

Method: Nuclear medicine procedures are based on pathophysiological processes so they can play an important role in the diagnosis of this type of HF. Radionuclide ventriculography (RNV), myocardial perfusion imaging (MPI), imaging of glucose metabolism (FDG), autonomous neuropathy and cardiac sarcoidosis and amyloidosis are the routinely used procedures.

Results: RNV serves mainly to detect changes of left ventricular function during physical stress, MPI to detect myocardial ischemia even when coronary aterosclerosis in not present, FDG is used to detect myocardial viability in patients after myocardial infarction. Autonomous neuropathy is dected as a sympathetic dysfunction. Scintigrahic procedures play a significant role in resctritive cardiomyopathies if the cause is sarcoidosis or amyloidosis. Scintigraphy of amyloidosis, in some circumstances, can even replace endomyocardial biopsy.

Conclusion: Scintigraphic procedures can play a significant role in the diagnosis of HFpEF. But they must be well indicated, profesionally performed and wisely interpreted.

Keywords:

PET – scintigraphy – HFpEF – SPECT

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