Molecular phenotyping of infiltrative cardiomyopathies: The future
- 258 Downloads
Cardiac sarcoidosis and amyloidosis have gained recent attention due to substantial advances in imaging and management. In this issue of the Journal of Nuclear Cardiology, imaging experts discuss the role of microvascular perfusion, innervation, targeted imaging of the heart and whole body, and novel molecular targets for imaging inflammation, fibrosis, and amyloidosis. In addition to cutting edge science, experts provide, for the first time, a patient page with information for patients with sarcoidosis and amyloidosis.
KeywordsCardiomyopathy amyloid heart disease sarcoid heart disease PET SPECT infiltrative
Infiltrative heart diseases exhibit substantial variation in pathogenesis, clinical manifestations, and clinical outcomes.1–3 Cardiac sarcoidosis and amyloidosis are the two infiltrative cardiomyopathies that have garnered most of the recent attention due to advances in imaging and management.
Advanced cardiovascular imaging has transformed the evaluation, management, and risk assessment of infiltrative heart diseases. Echocardiography is widely available and one of the most mature techniques with over 50 years of experience, but it detects advanced infiltration with increased left ventricular wall thickness/mass and is insensitive to diagnose early changes and response to therapy. Cardiac magnetic resonance imaging (CMR) is becoming increasingly available over the past decade, and provides high resolution, quantitative imaging with precise tissue characterization (fibrosis, inflammation edema, fat, and blood) and distinct phenotypic appearances (amyloidosis, sarcoidosis, Danon’s disease, Fabry’s disease). CMR, however, is not widely available, requires high technical expertise, and may be contraindicated in certain patients (eGFR < 30 mL/min, certain implanted devices etc.). Radionuclide imaging on the other hand is one of the most mature imaging techniques that is quantitative and provides exquisite sensitivity to detect pico/nano molar changes in the tissue. Moreover, radionuclide imaging offers distinct advantages over biopsy in characterizing infiltrative cardiomyopathy.
For the first time, effective targeted therapies4, 5, 6 will soon be available to slow progression of cardiac amyloidosis.6 In this issue of the Journal of Nuclear Cardiology, experts in the field discuss several topics including, emerging imaging targets for inflammation and fibrosis and the role of imaging in the evaluation of microvascular dysfunction, innervation, and targeted imaging of sarcoidosis and amyloidosis. In addition to cutting edge science, experts provide, for the first time, a patient page with information for patients with sarcoidosis and amyloidosis. Enjoy reading this theme issue of the Journal of Nuclear Cardiology on infiltrative cardiomyopathy.
Dr. Dorbala served as a consultant with Advanced Accelerator Applications, General Electric and Proclara. Dr. Shaw reports no relevant disclosures.