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Cardiac molecular imaging to track left ventricular remodeling in heart failure

  • Molecular Imaging Corner
  • Published:
Journal of Nuclear Cardiology Aims and scope

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.

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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

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

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Authors and Affiliations

  1. Department of Cardiology, St. Luke’s University Health Network, 801 Ostrum Street, Bethlehem, PA, USA

    Jamshid Shirani MD, Amitoj Singh MD & Sahil Agrawal MD

  2. Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Vasken Dilsizian MD

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Shirani, J., Singh, A., Agrawal, S. et al. Cardiac molecular imaging to track left ventricular remodeling in heart failure. J. Nucl. Cardiol. 24, 574–590 (2017). https://doi.org/10.1007/s12350-016-0620-2

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