Volume 44, Number 4

July 2014

Letter from the Guest Editor: Update in Cardiovascular Nuclear Medicine here have been many advances in the field of cardiovascular nuclear imaging since the most recent review of the topic in Seminars in Nuclear Medicine almost 10 years ago in January 2005. The assortment of articles by leaders in the field in this part 1 issue and in the part 2 issue coming in September provides in-depth descriptions of SPECT, PET, and hybrid imaging technological advancements related to acquiring and processing cardiac images using current standard and potential new radiotracers, better understood and expanded clinical applications in patients with a variety of heart conditions that include not only coronary artery disease but also heart failure and associated pathologies, and prospects for future applications of radionuclide cardiac imaging to view the molecular processes underlying disease. In particular, in this issue, the series opens with 2 outstanding, complementary reviews of camera hardware and computer processing software developments by Dr Piotr Slomka and colleagues, and Dr E. Gordon DePuey, respectively. The first of these describes novel SPECT cameras with highly efficient solid-state photon detectors that improve image quality well beyond that of the more than 50-year-old standard Anger camera solid-crystal, photomultiplier tube detector design. The authors further explain improved collimation techniques as well as PET hardware developments that improve image resolution and contrast and reduce image noise. The second is an easy-to-follow review of complex advanced processing techniques that improve the efficiency of standard SPECT systems. These hardware and software advances not only enhance image quality and diagnostic accuracy but also improve patient comfort from shortened imaging times and increase patient safety through reduced radiation exposure. In the third article, Dr Thomas Schindler and colleagues point to the need to go beyond the current standard of myocardial perfusion image interpretation that employs qualitative and semiquantitative assessments of relative blood flow (essentially, descriptions of heterogeneity versus homogeneity of tracer uptake) to using true quantitative flow techniques, that is, coronary flow reserve

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http://dx.doi.org/10.1053/j.semnuclmed.2014.04.007 0001-2998/& 2014 Elsevier Inc. All rights reserved.

and absolute coronary blood flow. The current standard methodology can significantly underestimate coronary disease, sometimes missing it entirely if flow reduction is uniformly balanced. Dr Schindler describes actual quantitative flow measurements that can overcome missing disease in the setting of balanced ischemia, should better characterize the extent of disease burden if abnormalities are seen, and has potential to identify subclinical disease that might prompt closer patient vigilance and more aggressive risk factor reduction to prevent future adverse cardiac events. Heart failure remains a major burden to society with a high morbidity and mortality and also from high resource-draining costs that include increased use of expensive mechanical devices. The articles by Dr Travin and by Drs Soman and Chen provide detailed reviews of current and upcoming radionuclide imaging methods for patients with heart failure. The first article describes cardiac autonomic imaging that, given recent Food and Drug Administration approval of 123 I-mIBG (meta-iodobenzylguanidine) for cardiac imaging, is expected to become part of routine heart failure imaging and help guide implantable defibrillator use. The second article deals with assessment of left ventricular mechanical synchrony that can direct use of cardiac resynchronization therapy. Finally, in the current era, spectacular images, accurate diagnoses, and even fine detailed risk stratification are no longer adequate if imaging is to thrive. The review by Drs Cremer, Hachamovitch, and Tamarappoo shows that it is crucial that the proper imaging techniques be used on the correct patients such that the findings will influence management and results in improved patient outcome and well-being more optimally than would be the case with less expensive techniques. Cardiovascular disease accounts for 1 of every 3 deaths in the United States, remaining higher than any other major cause of death.1 The disease drains enormous economic resources, estimated to be more than $300 billion in 2010. The authors of this 2-part series on radionuclide cardiac imaging believe that our techniques offer unique benefit over other choices and

Guest editorial currently have and will provide even more value in overcoming this large personal health and societal burden. Mark I. Travin, MD Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY E-mail address: mtravin@montefiore.org

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Reference 1. Go AS, Mozaffarian D, Roger VL, et al: Heart disease and stroke statistics— 2014 Update: A report from the American Heart Association. Circulation 2014;129:e28-e92

Letter from the guest editor: update in cardiovascular nuclear medicine.

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