ABC | Volume 114, Nº2, February 2020

Update Update of the Brazilian Guideline on Nuclear Cardiology – 2020 Arq Bras Cardiol. 2020; 114(2):325-429 Table 30 – Established and potential indications for cardiac scintigraphy with MIBG- 123 I Clinical Scenarios Established Potential HFrEF • Risk stratification, regardless of other parameters; evaluation of progression of HF, arrhythmic events, and total cardiac mortality up to 2 years • Identification of a low-risk subgroup for cardiac events and mortality • Clinical follow-up of medical therapies indicated in the guidelines • Identification of patients most likely to benefit from CRT or LVAD • Guiding treatment of patients with LVAD: bridge to transplant, possible explant • Substitute marker for evaluating benefits of new medical therapies and devices HFpEF • Subanalyses of larger studies have shown a risk stratification similar to that seen in patients with HFrEF • Identification of patients whose risks may be higher than clinically apparent Arrhythmias associated with HF • Risk stratification for lethal or potentially lethal ventricular arrhythmias for up to 2 years • Identification of patients with very low risks of lethal arrhythmic events for up to 2 years • Refining indication criteria for patients who will benefit from ICD • Helping identify patients who will no longer need ICD, at the end of battery life or device infection Primary arrhythmic conditions • Identification of patients with risks of worse outcomes, including arrhythmic events and total mortality • Improving understanding of physiopathology of primary arrhythmic conditions • Guiding conduct for patients with primary arrhythmic conditions Heart transplant • Following post-transplant cardiac reinnervation after • Identification of patients who are more likely to have complications following transplant, including transplant rejection and transplant by CAD Ischemic heart disease • Evaluation of area at risk in patients with acute coronary syndromes • Risk stratification in patients with hibernating myocardium • Guiding conduct for patients with acute coronary syndromes • Guiding conduct for patients following ischemic events • Ischemic memory Diabetes mellitus • Identification of cardiac autonomic abnormalities, including patients without extracardiac manifestations • Identification of patients whose risks may be higher than clinically apparent, assisting in diagnosis and orienting appropriate treatment Cardiotoxicity due to • Identification and quantification of cardiac lesions in patients undergoing these treatments • Guiding conduct of chemotherapy • Improving understanding of the physiopathology of toxicity due to drugs MIBG- 123 I: metaiodobenzylguanidine labeled with iodine-123; CAD: coronary artery disease; CRT: cardiac resynchronization therapy; HF: heart failure; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction; ICD: implantable cardioverter defibrillator; LVAD: left ventricular assist device. Adapted from JCS Joint Working Group. 339 Figure 54 – Abnormal cardiac scintigraphy with MIBG- 123 I of a patient with advanced heart failure and highly reduced radiopharmaceutical uptake in the cardiac area (arrow), which denotes cardiac sympathetic hyperactivity. Black and white images of the anterior thorax, acquired approximately 15 minutes (early) and 4 hours (late) following intravenous injection of the radiopharmaceutical MIBG- 123 I. Early Late 400