Nuclear Cardiology in Asia

Area of Science:

• Cardiology
• Nuclear Medicine
• Radiology

Background:

• Nuclear cardiology practice for ischemic heart disease and heart failure is growing in Asia, but utilization rates differ significantly across countries.
• Utilization ranges from over 1000 scans/100,000 inhabitants in Israel and Korea to limited or no practice in Central Asia and parts of Southeast Asia.

Purpose of the Study:

• To evaluate myocardial ischemia in symptomatic patients with chest pain using Myocardial Perfusion Imaging (MPI) SPECT.
• To assess the effects of percutaneous coronary intervention and coronary artery bypass graft on cardiac function.
• To evaluate cardiac function in patients with chronic heart failure.

Main Methods:

• Myocardial Perfusion Imaging (MPI) SPECT studies were conducted.
• Characterization of MPI practices included the use of Thallium-201 (²⁰¹Tl) and Technetium-99m (^99mTc) dosing, stress-only imaging rates, and effective radiation doses.
• Regional normal databases from China and Japan were used for threshold values of left ventricular ejection fraction, end-systolic volume, and end-diastolic volume.

Main Results:

• Asia exhibits heterogeneous nuclear cardiology utilization, with Israel and Korea showing the highest rates and many Southeast Asian and Central Asian countries showing limited use.
• MPI practices in Asia often involve more frequent use of ²⁰¹Tl, less weight-based ^99mTc dosing, and lower rates of stress-only imaging, leading to higher effective doses compared to global averages.
• ^99mTc-based MPI demonstrated efficacy in predicting cardiac events in Asian populations with low ischemic heart disease risk.

Conclusions:

• Significant disparities exist in nuclear cardiology adoption across Asia, necessitating targeted development strategies.
• Specific imaging protocols in Asia contribute to higher effective radiation doses, highlighting a need for optimization.
• Enhancing human resources in nuclear medicine and increasing public awareness are essential for promoting nuclear cardiology in Asia, supported by international and regional organizations.