ABC | Volume 114, Nº2, February 2020

Editorial Nuclear Cardiology in 2020 – Perspectives of the New SBC Guideline Cláudio Tinoco Mesquita, 1, 2 Wilter dos Santos Ker, 2 Jader Cunha de Azevedo 1,3 Departamento de Radiologia – Hospital Universitário Antônio Pedro – Empresa Brasileira de Serviços Hospitalares – Universidade Federal Fluminense (EBSERH–UFF), 1 Niterói, RJ – Brazil Hospital Pró-Cardíaco, 2 Rio de Janeiro, RJ – Brazil Serviço de Medicina Nuclear – Hospital Universitário Clementino Fraga Filho–Universidade Federal do Rio de Janeiro (HUCFF–UFRJ), 3 Rio de Janeiro, RJ – Brazil Mailing Address: Cláudio Tinoco Mesquita • Hospital Universitário Antônio Pedro – Setor de Medicina Nuclear – Av. Marquês de Paraná, 303/2° andar. Postal Code 24030-210, Centro, Niterói, RJ – Brazil E-mail: claudiotinocomesquita@id.uff.br Keywords Coronary Artery Disease/diagnostic imaging; Myocardial Perfusion Imaging/methods; Prognosis; Biomedical Technology/ trends; Positron Emission Tomography Computed Tomography/ trends; Tomography Emission-Computed, Single/methods. DOI: https://doi.org/10.36660/abc.20190874 To get to know, to discover, to communicate François Arago French physicist François Arago’s quote is one of the most powerful summaries of scientific activity, starting with the search for existing knowledge, followed by the discovery of new information and culminating in their prompt communication. This flow is essential for scientific progress to reach and transform society. Thus, in the medical area, guidelines are considered to be essential for the organization and guidance of conducts and knowledge in a structured manner and within a pre-established method. The development of consistent and up-to-date guidelines is one of the most important tasks of a medical specialty society and involves the considerable effort of multiple specialists in the field of knowledge, reviewers, layout editors, among others. In addition to the arduous and complex task, the preparation of recommendations has against it the uninterrupted flow of publications that appear every day and that can change the current state of knowledge. We should highlight the amplitude, up-to-date status, and extensive applicability of this Nuclear Cardiology Guideline 1 jointly developed by the Nuclear Cardiology Area of the Department of Ergometry, Exercise, Nuclear Cardiology and Cardiovascular Rehabilitation (DERC), by the Department of Cardiovascular Imaging (DIC) of the Brazilian Society of Cardiology (SBC) and the Brazilian Society of Nuclear Medicine (SBMN). In little over a decade, the management of chronic coronary artery disease (CAD) has undergone a paradigmatic shift towards an optimized clinical treatment, which consistently reduces the progression of atherosclerosis and prevents thrombosis and acute coronary syndrome. 2 Myocardial revascularization is indicated in acute cases, in higher risk cases and in those whose symptoms are progressive or refractory to drug treatment. 3,4 The SBC Nuclear Cardiology Guideline joins the Chronic Coronary Syndrome Guideline, reinforcing the importance of functional methods in the diagnosis of the etiology of symptoms in patients with suspected CAD, identifying the most at-risk patients, in therapeutic decision‑making and in the follow-up of treatment response. 4 The question whether myocardial revascularization should be the initial management strategy in patients with chronic CAD and moderate to severe ischemia 5 seems to have been answered with the presentation of the ISCHEMIA Study, which showed no benefit from routine revascularization when added to optimized drug treatment. 6 However, we highlight the role of revascularization in improving symptoms and quality of life, reinforcing the importance of shared and individualized decision-making in patients who remain symptomatic despite optimized clinical treatment. Notably, several situations that were excluded from the ISCHEMIA study are covered in detail in the text of the Nuclear Cardiology Guideline, 1 such as patients with coronary trunk injury, recent acute coronary syndrome, angioplasty in the last 12 months, ejection fraction < 35% and those with progressive or unstable symptoms. It is important to emphasize that Nuclear Cardiology is not restricted to the study of coronary disease only, but has undergone a revolution in recent years, with advances in equipment, software and tracers that make it important in the management of several conditions, for which the cardiologist previously had no tools to meet their needs. The Nuclear Cardiology Guideline 1 takes a comprehensive and practical approach to this new application for the cardiologist. In Figure 1 we show some of the new applications in which nuclear cardiology has important practical significance. Among the new applications of nuclear cardiology, we highlight the use of 18F-FDG PET-CT and labeled leukocyte scintigraphy, as they were the nuclear medicine techniques included in the international algorithms and consensuses of investigation of infectious endocarditis in valve prostheses and in cases of suspected infection in implantable devices, such as pacemakers and defibrillators. 7 The SBC Nuclear Cardiology Guideline addresses in detail the basis of the use of these techniques in modern cardiology practice. Another important new recommendation for the use of 18‑FDG PET-CT included in the guideline is cardiac sarcoidosis. In addition to a vital contribution to the diagnosis of cardiac sarcoidosis, 8 PET-CT is crucial for monitoring treatment response, and its serial use is recommended to guide the use of immunosuppressants and anti-inflammatory drugs. 9 Nuclear cardiology has become important in the diagnosis of cardiac amyloidosis caused by transthyretin deposits. A positive result in a scintigraphy with bone tracers, such as 99m-Technetium pyrophosphate, in the absence of light 196