ABC | Volume 114, Nº2, February 2020

Editorial Mesquita et al. Nuclear Cardiology in 2020 – Perspectives of the new SBC Guideline Arq Bras Cardiol. 2020; 114(2):196-198 Figure 1 – New applications of nuclear medicine in Cardiology where the use of the technique provides diagnostic, prognostic or guiding therapeutic decision-making information. chain screening in blood and urine, allows the diagnosis of cardiac amyloidosis by transthyretin and correlates with the cardiac biopsy, which may prevent the latter. With the development of treatments that delay the deposition of transthyretin protein in the heart and reduce mortality and morbidity, myocardial pyrophosphate scintigraphy has gained additional relevance. 10,11 The use of 123I-MIBG cardiac scintigraphy is based on the unique opportunity to evaluate the autonomous sympathetic component of cardiac innervation. The adrenergic impairment identified with this technique allows early detection of cardiotoxicity related to cancer treatment, stratifying the risk of sudden death in patients with heart failure 12 and assisting in the diagnosis of Tako-Tsubo Syndrome. 13 A modern and evolving chapter of Nuclear Cardiology, which is addressed in the SBC Guideline, is the assessment of microcirculation. Data from the Core 320 study and the ISCHEMIA study itself confirmed that a significant number of patients have angina and ischemia in the absence of coronary obstruction. 14 The evaluation of these patients using PET-CT techniques allowed us to identify the presence of microvascular ischemia as responsible for most cases, which implies an adverse prognosis and specific treatment. 15 The flow reserve assessment through PET-CT is the most appropriate technique to investigate these cases and is recommended in international guidelines and in the SBC Guideline. With the rapid advancement of high-performance machines with solid CZT detectors and improved software, the new SPECT chambers allow high-quality images with low radiation exposure and will contribute to the evaluation of these cases with studies demonstrating their validation, in comparison to the PET-CT equipment. 16 The recognition of microvascular angina reinforces the importance of functional techniques and that a CAD assessment focused on the anatomy of CAD may lead to the underdiagnosis in cases of microvascular angina and overtreatment in cases where anatomic lesions do not have a functional significance. One last part to be highlighted is the intersection between the several imaging modalities with hybrid equipment and software that allow the collection and analysis of nuclear cardiology data concomitantly with computed tomography or magnetic resonance imaging. The integration of exam information from different modalities into SPECT-CT, PET‑CT and PET-MR equipment enhances the amount and quality of available information for cardiologists to make decisions in patient management. Even the integration of information from exams acquired from separate equipment can increase the potential for risk stratification and improve patient management. 17 Ongoing studies will allow better definition of which patient groups will routinely benefit from these strategies. In conclusion, cardiology has come a long way in recent years and so has nuclear cardiology. The new nuclear cardiology guideline by SBC enables us to learn about the most significant findings and publications through structured recommendations that impact the practice of modern cardiology. 197