Includes References and Index

The synthesis of molecular radiotracers in parallel with recent advances in hybrid imaging has
made it possible to study and characterize cardiac anatomy, function, perfusion, metabolism,
and innervation in vivo, with exceptional accuracy. The ability to image the shift in the primary
source of myocardial energy production from fatty acids toward glucose utilization in the setting of reduced blood flow has helped explain the pathophysiology of hibernation and myocardial viability, as well as management of patients with chronic ischemic left ventricular
dysfunction and heart failure for the assessment of myocardial viability. The neuronal component of the myocardium, however, has been sparingly evaluated. This might be an inadvertent
oversight, or an apt omission due to its interaction with the abnormalities produced by other
myocardial compartments, that have been more easily measured.
The heart and the brain have complex interconnected communications with the heart supplying blood to the brain and the brain exerting neuronal control over cardiac function. Some
central nervous system and myopathies are associated and often determine patient outcome,
while other cardiac neurological conditions are concurrent but not causally related. Remodeling
of the cardiac innervation, for example, may play a critical role in the development of heart
failure rather than being a response to the disease process. Imaging cardiac innervation may
provide insight into central versus regional intrathoracic autonomic nervous system disorders.
Understanding the neurohumoral basis of the diseased heart (e.g., overactivation of cardiac
sympathetic efferent neurons and the renin-angiotensin system) may have important implications for treatment options.
Molecular imaging allows direct visualization and characterization of the neuronal component and function of living cardiac cells. It provides an entirely new and unanticipated window
of opportunity for simultaneous assessment of cardiac structure and function, noninvasively, as
well as image-guided therapy. The aim of the Atlas of Cardiac Innervation is to elucidate the
role of neuronal component in normal and disease states and discuss various imaging targets
and probes that are currently available in clinical practice. All contributors have made sincere
efforts to include the latest developments in their chapters. The chapters are intended to provide the reader a firm foundation in cardiac neuronal imaging and image processing to effectively utilize these techniques in the clinical setting and/or in the research setting to develop
new ones. Schematic diagrams, tables, and diagnostic algorithms are interspersed with color
illustrations to emphasize key concepts in cardiovascular physiology, pathology, and
innervation.
In the first two chapters (Chaps. 1 and 2), the principles of autonomic control in the regulation of cardiac function, sympathetic and parasympathetic innervation, and circulating neurohormones are presented in health and disease. Chapter 3 details the chemistry and biology of
radiotracers designed to target changes in the myocardial sympathetic and parasympathetic
innervation as a function of disease or treatment. The next three chapters (Chaps. 4, 5 and 6)
address neuronal imaging in heart failure and reverse remodeling, as well as the future role of
PET imaging and quantification of cardiac innervation. Chapters 7 and 8 discuss cardiac sympathetic innervation in ventricular arrhythmias and device therapy, and its role for guiding
ablation of ventricular tachycardia. Chapter 9 covers conditions which affect the autonomic
nervous system, from brain disorders to neuropathies, including diabetes mellitus. Chapter 10 examines the role of myocardial blood flow and cardiac neuronal imaging in denervation and
reinnervation in cardiac transplant recipients.
Extraordinary advances in basic sciences and molecular imaging techniques in recent years
have enabled scientists to address classic questions of cardiovascular discipline. Targeted
imaging of cardiac innervation and the use of image-guided therapy will further improve the
management of heart failure by identifying patients for whom the response to medical, device,
or ablation therapy would be optimal or perhaps not beneficial at all, as we move closer to
personalized medicine. It would not be an overstatement to say that molecular imaging, particularly the neuronal component of the myocardium, will revolutionize research in many areas
of cardiovascular diseases. In the next century, innovative neuronal imaging strategies will
propel the field from diagnostic to image-guided therapeutic procedures. It is our hope that the
Atlas of Cardiac Innervation will serve as a foundation for clinicians and electrophysiologists
and foster cross-fertilization among investigators from various disciplines.