Atualização da Diretriz Brasileira de Cardiologia Nuclear – 2020: Atualização da Diretriz Brasileira de Cardiologia Nuclear – 2020

Nuclear cardiology is a non-anatomical, physiological imaging method. The use of radioactive or radiopharmaceutical substances makes it possible to study several physiopathological mechanisms of cardiovascular disease in vivo. Via this imaging technique, it is also possible to visualize and accompany an instituted therapy’s physiological effects on cardiac function, on the cellular and biochemical level. Of all the applications of nuclear medicine in cardiology, scintigraphy or myocardial perfusion imaging with technetium-99m-labeled radiopharmaceuticals synchronized with electrocardiogram (Gated-SPECT), is the most common exam in clinical practice. For this reason, this technique will be the most discussed in these Guidelines. Recent years have, however, seen a growing concern among the scientific community regarding rational and optimized use of ionizing radiation in medicine. Cardiovascular imaging, moreover, encompasses all functional and anatomical imaging techniques and should, in this context, be used rationally and cost-effectively. Other applications of nuclear medicine in cardiology have also emerged and gained prominence during the past decades, especially positron emission tomography (PET) for the study of coronary flow reserve, cardiac sympathetic activity, and inflammatory/infectious processes, and cardiac amyloidosis (CA). All of these aspects have been taken into consideration and will be covered in detail in the chapters developed herein. Guidelines recommendations are highly valuable tools for medical activity of the highest quality. The objective is to support and aid doctors in making decisions regarding their patients, by elaborating orientations which may be useful as part of the decision-making process. No Guidelines, however, should be replaced by the abilities, experience, and clinical judgments of specialized professionals who are have the final say in their decisions concerning each individual patient. In general, whenever possible and applicable, classifications of recommendation have been adopted for indicating cardiac scintigraphy, supported by levels of evidence, in accordance with the recommendations established by classical cardiology guidelines (Table 1). Table 1 Classes of recommendation and levels of evidence