新型f -18标记的交感神经功能示踪剂可改善风险分层和临床结果。

IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Fatema Tuj Zohora, Matthew A Nazari, Albert J Sinusas
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引用次数: 0

摘要

综述目的:本文综述了新型18f标记正电子发射断层扫描(PET)交感神经示踪剂在缺血性心脏病患者危险分层中的作用。PET示踪剂通过表征心肌交感神经密度和扩大心肌交感神经去支配的程度,证明了其预后价值。讨论了这些PET示踪剂的独特特征与临床应用的关系。最近的发现:使用18f标记的PET示踪剂可以对交感神经断神经进行绝对量化,其性能优于低射血分数(18f标记的放射性示踪剂具有较长的半衰期,允许集中合成和运输到其使用点。因此,18f标记的交感神经示踪剂定义了一种创新,可能为心血管疾病患者的风险评估提供一种更实惠和临床实用的方法。18f标记的交感神经示踪剂目前可用于缺血性心脏病和心力衰竭患者的评估和风险分层。这些放射性示踪剂可以为选择ICD的放置位置和随后的SCD预防提供更实用的方法;这是心力衰竭患者和所有SCD患者尚未满足的主要需求。然而,需要进一步开发和临床测试这些18f标记的交感神经示踪剂。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Novel F-18-labeled Tracers of Sympathetic Function for Improved Risk Stratification and Clinical Outcomes.

Purpose of review: This review summarizes the role of the novel 18F-labeled positron emission tomography (PET) sympathetic radiotracers for risk stratification in patients with ischemic heart disease. PET tracers have demonstrated prognostic value by characterizing myocardial sympathetic nerve density and by extension the extent of myocardial sympathetic denervation. The unique features of these PET radiotracers are discussed in relation to clinical application.

Recent findings: Absolute quantification of sympathetic denervation has been possible with 18F-labeled PET tracers which outperform low ejection fraction (<35%) in predicting sudden cardiac death (SCD) and allow for more optimal risk stratification in patients with heart failure. This underscores their utility in selecting patients for preventable strategies with implantable cardioverter defibrillators (ICD). Appropriate candidate selection for ICD placement is a major priority as at present 80% of patients that die from SCD do not receive an ICD (potentially preventable mortality) while only 1 in 8 patients with an ICD receive a life-saving shock. Furthermore, 1 in 3 patients with ICDs receive inappropriate shocks. Thus, there is a pressing need to more appropriately select and exclude patients who will and will not benefit from ICD placement, respectively, as both suffer poor outcomes. Despite the clear prognostic benefit offered by prior PET sympathetic radiotracers in imaging myocardial sympathetic denervation, their short half-lives necessitated costly onsite cyclotron synthesis obviating their pragmatic clinical use. 18F-labeled radiotracers have a longer half-life allowing centralized synthesis and transport to their point of use. As such, 18F-labeled sympathetic radiotracers define an innovation and may offer a more affordable and clinically practical approach for evaluation of risk in patients with cardiovascular disease. 18F-labeled sympathetic radiotracers are currently available for evaluation and risk stratification of patients with ischemic heart disease and heart failure. These radiotracers may offer a more practical approach for selection of ICD placement and consequent prevention of SCD; a major, yet unmet need, in heart failure patients and those that suffer SCD at large. However, further development and clinical testing of these 18F-labeled sympathetic radiotracers is required.

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来源期刊
Current Cardiology Reports
Current Cardiology Reports CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
6.20
自引率
2.70%
发文量
209
期刊介绍: The aim of this journal is to provide timely perspectives from experts on current advances in cardiovascular medicine. We also seek to provide reviews that highlight the most important recently published papers selected from the wealth of available cardiovascular literature. We accomplish this aim by appointing key authorities in major subject areas across the discipline. Section editors select topics to be reviewed by leading experts who emphasize recent developments and highlight important papers published over the past year. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.
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