Gary V. Heller, MD, PhD

Medical Advisor

Dr. Heller has more than 30 years of experience in clinical cardiology and nuclear cardiology. He established the first PET program in Connecticut that focused on cardiac perfusion, myocardial viability assessment and cardiac sarcoid. He is a former program director of the Cardiovascular Fellowship Program at Hartford Hospital/University of Connecticut School of Medicine. Dr. Heller is past-president of the American Society of Nuclear Cardiology and has been a member of the Editorial Boards of several journals including American Journal of Cardiology, Journal of the American College of Cardiology, and the Journal of Nuclear Cardiology. He is also past-president of the Intersocietal Accreditation Commission (IAC), as well as past-president of the IAC-Nuclear-PET Division. Dr. Heller has authored over 175 peer-reviewed manuscripts, he is also Co-editor of Nuclear Cardiology Practical Applications (2nd Edition, McGraw Hill), Nuclear Cardiology: Technical Applications (McGraw Hill), and the Handbook of Nuclear Cardiology: Cardiac SPECT and PET (Springer).

Implementation of a Cardiac PET program provides the best study with the highest diagnostic accuracy, most efficient protocols, lowest radiation exposure for your patients and the most economic study for your practice.

The Present and Future of Cardiac PET: Dr. Gary Heller

cardiac PET

Present

Where is PET today?

“The present of cardiac PET continues its dynamic evolution while the future of cardiac PET holds very compelling opportunities for the patient and clinical practice.” The diagnostic accuracy for cardiac PET MPI has been established from multiple studies and shown to be superior to conventional SPECT MPI with regards to both sensitivity and specificity. This, combined with a documented higher image quality provides compelling reasons to move to cardiac PET. An additional factor favoring PET MPI to SPECT MPI is minimized radiation exposure to both patients and staff preforming procedures. The average radiation exposure for a rest/stress cardiac PET using 40mCi of Rubidium-82 is 3-4mSv when compared to 10-15 mSv for single Isotope and 20-25 mSv for dual isotope SPECT. In addition, using 3D imaging techniques can lead to even further reduction in radiation exposure. Cardiac PET offers additional information to improve diagnostic accuracy such as reversible wall motion abnormalities and myocardial blood flow is now commonly implemented in many PET laboratories. Laboratory efficiency is also a major factor for considering PET. Although, it is commonly assumed that PET instrumentation is exponentially more expensive than SPECT. For those considering PET, it is important to recognize the breadth of available equipment. Dedicated line-source PET as well as 8-16 slice PET/CT cameras are in fact competitive in cost with new high-end SPECT cameras. As the field of imaging moves from “volume to value” in which downstream testing is targeted towards those needing intervention, cardiac PET is an excellent option. Finally, as the depth of other cardiovascular imaging procedures used to diagnose myocardial viability, cardiac sarcoid evaluation, inflammation/infection imaging take on more relevance, cardiac PET is becoming a vital diagnostic tool in cardiovascular practice.

cardiac PET

Future

Where are we going?

Cardiac PET in the future is also compelling. From an overall perspective, those procedures that offer the most benefit to society will gain use and acceptance. The higher accuracy and image quality of cardiac PET imaging will continue to demonstrate value in reserving down-stream evaluation for those patients needing procedures, not diagnosis. Current multi-center research trials being performed today will yield results in data that support the growing value of PET. Of great interest and excitement is the breadth of the development of new cardiac PET tracers to grow and expand the indications to preform cardiac PET. There are two new F-18 perfusion tracers in FDA development now that will provide better image quality and the ability to perform exercise stress with cardiac PET MPI procedures, a limitation in the current scheme. The longer half-life (2 hours) will also mean that laboratories will be able to purchase the tracer on a patient-by-patient basis. An ischemic memory tracer in development offers some unique features to identifying CAD, perhaps without stress testing. A neuronal imaging agent analogous to mIBG but with much higher imaging quality may open this area for further research and indications. Further, F-18 FDG imaging for cardiac indications continues to grow in value and use in the clinical setting. Finally, as the cardiac PET volume grows, manufacturers are looking towards development of new, lower cost, and targeted PET/CT cameras for the cardiac market.

Is your practice maximizing cardiac services?

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