Regional Distribution of Fluorine-18-Flubrobenguane and Carbon-11-Hydroxyephedrine for Cardiac PET Imaging of Sympathetic Innervation

• Published in: JACC. Cardiovascular imaging 2021-07, Vol.14 (7), p.1425-1436
• Main Authors: Zelt, Jason G.E., Britt, Deron, Mair, Braeden A., Rotstein, Benjamin H., Quigley, Sarah, Walter, Olga, Garrard, Linda, Robinson, Simon, Mielniczuk, Lisa M., deKemp, Robert A., Beanlands, Rob S.
• Format: Article
• Language: English
• Subjects: ischemic cardiomyopathy; positron emission tomography; sudden cardiac death; sympathetic nervous system
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2020.09.026

The aim of this study was to investigate the regional distribution of novel 18F-labeled positron emission tomographic (PET) tracer flubrobenguane (FBBG) (whose longer half-life could enable more widespread use) to assess myocardial presynaptic sympathetic nerve function in humans in comparison to [11C]meta-hydroxyephedrine (HED). The sympathetic nervous system (SNS) is vitally linked to cardiovascular regulation and disease. SNS imaging has shown prognostic value. HED is the most commonly used PET tracer for evaluation of sympathetic function in humans, but widespread clinical use is limited because of the short half-life of 11C. A total of 25 participants (n = 6 healthy; n = 14 ischemic cardiomyopathy, left ventricular [LV] ejection fraction [EF] = 34 ± 5%; and n = 5 nonischemic cardiomyopathy, EF = 33 ± 3%) underwent 2 separate PET imaging visits 8.7 ± 7.6 days apart. On 1 visit, participants underwent dynamic HED PET imaging. On a different visit, participants underwent dynamic FBBG PET imaging. The order of testing was random. HED and FBBG global innervation (retention index [RI] and distribution volume [DV]) and regional denervation (% nonuniformity) were quantified to assess regional presynaptic sympathetic innervations. FBBG RI (r2 = 0.72; ICC = 0.79; p