Imágenes de inervación miocárdica: MIBG en práctica clínica
DOI:
https://doi.org/10.54502/msuceva.v2n2a3Palabras clave:
Imágenes, inervación cardíaca, insuficiencia cardíaca, función simpática, MIBGResumen
La 123I-metayodobencilguanidina (MIBG) es un análogo de norepinefrina radiomarcado que se puede usar para investigar la inervación simpática del miocardio. La gammagrafía con 123I-MIBG se ha investigado con interés en muchos contextos patológicos. En pacientes con insuficiencia cardiaca (IC) sistólica, la gammagrafía con 123I-MIBG puede detectar el deterioro funcional y la rarefacción de las terminales simpáticas (que se manifiestan como reducción de la relación corazón-mediastino [H/M] temprana y tardía en la gammagrafía planar) y aumento del flujo de salida simpático (que puede visualizarse como una alta tasa de lavado). Estos hallazgos se han asociado consistentemente con un peor resultado: más notablemente, un ensayo de fase 3, encontró que los pacientes con un H/M tardío 1.60, poseen una mayor incidencia de mortalidad cardiovascular y por todas las causas y arritmias potencialmente mortales durante un seguimiento de menos de 2 años. A pesar de estos hallazgos prometedores, la gammagrafía con 123I-MIBG aún no ha sido recomendada por las principales guías de IC como una herramienta para la estratificación del riesgo aditivo y nunca ha entrado en la etapa de adopción generalizada en la práctica clínica actual. La gammagrafía con 123I-MIBG también se ha evaluado en pacientes con infarto de miocardio, trastornos genéticos caracterizados por una mayor susceptibilidad a las arritmias ventriculares y varias otras condiciones caracterizadas por alteración de la inervación miocárdica simpática. En la presente revisión, se resumirá el estado del arte de la gammagrafía cardíaca con 123I-MIBG, los problemas actuales sin resolver y las posibles direcciones de la investigación futura.
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