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Journal of Nuclear Cardiology

, Volume 24, Issue 2, pp 574–590 | Cite as

Cardiac molecular imaging to track left ventricular remodeling in heart failure

  • Jamshid Shirani
  • Amitoj Singh
  • Sahil Agrawal
  • Vasken Dilsizian
Molecular Imaging Corner

Abstract

Cardiac left ventricular (LV) remodeling is the final common pathway of most primary cardiovascular diseases that manifest clinically as heart failure (HF). The more advanced the systolic HF and LV dysfunction, the worse the prognosis. The knowledge of the molecular, cellular, and neurohormonal mechanisms that lead to myocardial dysfunction and symptomatic HF has expanded rapidly and has allowed sophisticated approaches to understanding and management of the disease. New therapeutic targets for pharmacologic intervention in HF have also been identified through discovery of novel cellular and molecular components of membrane-bound receptor-mediated intracellular signal transduction cascades. Despite all advances, however, the prognosis of systolic HF has remained poor in general. This is, at least in part, related to the (1) relatively late institution of treatment due to reliance on gross functional and structural abnormalities that define the “heart failure phenotype” clinically; (2) remarkable genetic-based interindividual variations in the contribution of each of the many molecular components of cardiac remodeling; and (3) inability to monitor the activity of individual pathways to cardiac remodeling in order to estimate the potential benefits of pharmacologic agents, monitor the need for dose titration, and minimize side effects. Imaging of the recognized ultrastructural components of cardiac remodeling can allow redefinition of heart failure based on its “molecular phenotype,” and provide a guide to implementation of “personalized” and “evidence-based” evaluation, treatment, and longitudinal monitoring of the disease beyond what is currently available through randomized controlled clinical trials.

Keywords

Molecular imaging left ventricular remodeling perfusion imaging metabolism innervation 

Abbreviations

CAD

Coronary artery disease

CMR

Cardiac magnetic resonance

CT

Computed tomography

FDG

2-deoxy-2-(18F)fluoro-d-glucose

HF

Heart failure

LV

Left ventricle (ventricular)

MRI

Magnetic resonance imaging

MRS

Magnetic resonance spectroscopy

PET

Positron emission tomography

SPECT

Single-photon emission computed tomography

Notes

Disclosure

JS, AS, SA, and VD have no conflict of interest to disclose.

Supplementary material

12350_2016_620_MOESM1_ESM.pptx (189 kb)
Supplementary material 1 (PPTX 189 kb)

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Copyright information

© American Society of Nuclear Cardiology 2016

Authors and Affiliations

  • Jamshid Shirani
    • 1
  • Amitoj Singh
    • 1
  • Sahil Agrawal
    • 1
  • Vasken Dilsizian
    • 2
  1. 1.Department of CardiologySt. Luke’s University Health NetworkBethlehemUSA
  2. 2.Department of Diagnostic Radiology and Nuclear MedicineUniversity of Maryland School of MedicineBaltimoreUSA

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