Imaging cardiac innervation

Cardiac autonomic nervous system contributes to maintain haemodynamic and electrophysiological stability to changing demands. Cardiac innervation imaging can be performed by means of planar scintigraphy/SPECT or PET using different radiotracers developed for the assessment of pre- and postsynaptic receptors of the cardiac autonomic nervous system, with sufficient sensitivity to assess a process that takes place at picomolar concentrations. Clinically, cardiac innervation imaging is mainly performed targeting postganglionic presynaptic sympathetic neurons by means of myocardial 123I-metaiodobenzylguanidine (123I-mIBG) planar scintigraphy and SPECT, which has shown to be of value in the assessment of patients with different cardiac disorders, especially in those with heart failure (HF), having an independent prognostic value. This clinically oriented chapter updates the subject with inclusion of new data reinforcing the use of sympathetic cardiac innervation imaging for improving patient management.