The Future of Cardiac Molecular Imaging

Farber, Gedaliah; Boczar, Kevin E.; Wiefels, Christiane; Zelt, Jason G.E.; Güler, Emel; deKemp, Robert A.; Rotstein, Benjamin H.

doi:10.1053/j.semnuclmed.2020.02.005

Cited by 24 publications

(21 citation statements)

References 194 publications

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“…PET-CT is currently the leading molecular test in the diagnosis of unstable carotid plaque, however, focused mainly on the assessment of the inflammation within the plaque. The discovery of new radiotracers (with increased availability, biological sensitivity and more effectively target alternative processes) should change this situation (88). Many of these radiotracers may have been developed and adopted from other domains, such as oncology or neuroimaging.…”

Section: Discussionmentioning

confidence: 99%

New insight into biology, molecular diagnostics and treatment options of unstable carotid atherosclerotic plaque: a narrative review

Migdalski¹,

Jawień²

2021

Ann Transl Med

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Indications for intervention in hemodynamically relevant carotid artery stenosis (carotid endarterectomy or stenting) are primarily based on a degree of stenosis and symptomatology. To date the plaque vulnerability is rarely taken into account in clinical decision making although development of molecular imaging allows a better understanding of plaque biology and provides new techniques detecting potentially vulnerable plaque at risk. A significant number of reports describing the mechanisms of unstable plaque formation suggest that it is a multifactorial process. Inflammation, lipid accumulation, apoptosis, proteolysis, the thrombotic process and angiogenesis are among the main factors of carotid plaque destabilization. Although inflammation is a key process in development of plaque vulnerability, the hemostasis and neoangiogenesis should be regarded as equally important. Only a small group of asymptomatic patients may benefit from the invasive treatment and it remains a challenge to determine whether initially asymptomatic carotid plaque become unstable or vulnerable. Currently, the main task of research on atherosclerotic lesion imaging is focused on functional state of the plaque. The presence of one or more features such as stenosis progression, large plaque area, large juxta-luminal black area, plaque echolucency, intra-plaque hemorrhage, impaired cerebral vascular reserve and spontaneous embolization may indicate patients at higher risk for stroke suitable for revascularization. Treatment of carotid stenosis as one of the manifestations of generalized atherosclerosis requires a broad approach. Nowadays pharmacological treatment options for the atherosclerotic process are largely aimed at stimulating the plaque stabilization, but in symptomatic patients and selected asymptomatic patients, carotid plaque should be removed as a potential source of embolism.

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Section: Discussionmentioning

confidence: 99%

New insight into biology, molecular diagnostics and treatment options of unstable carotid atherosclerotic plaque: a narrative review

Migdalski¹,

Jawień²

2021

Ann Transl Med

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“…Advances in molecular imaging enable the measurement of myocardial energetic deficits and fibrotic activity. 5 A range of plasma and urinary biomarkers that provide an “omic fingerprint” to assess metabolism, inflammation, fibrosis, and hemodynamics may also be used to identify and manage personalized biotargets. Sodium-glucose cotransporter inhibitors may be effective in preventing heart failure in at-risk populations through a variety of putative effects on many of these disease processes.…”

Section: Can We Simplify Treatment Of Remission Based On Phenotype?mentioning

confidence: 99%

Maintaining Success for Patients With Dilated Cardiomyopathy and Remission of Heart Failure

Halliday

Cleland²

2022

JACC: Basic to Translational Science

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“…The combination of PET with CMR in a single acquisition is now possible with the emergence of new hybrid PET-CMR systems, thus the strengths of PET and CMR can be combined. Despite high costs, hybrid scanners can offer great benefits due to the high accuracy and reduced risk of complications [ 66 , 67 ]. The MRI has a high negative predictive value and excellent sensitivity in detecting fibrosis, and the PET is important for its ability to visualize and quantify inflammatory disease activity and extracardiac involvement.…”

Section: 18f-fdg Pet Study Of Cardiac Sarcoidosismentioning

confidence: 99%

Clinical Features and Diagnosis of Cardiac Sarcoidosis

Tana

Mantini

Donatiello

et al. 2021

JCM

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Cardiac sarcoidosis (CS) is an unusual, but potentially harmful, manifestation of systemic sarcoidosis (SA), a chronic disease characterized by organ involvement from noncaseating and nonnecrotizing granulomas. Lungs and intrathoracic lymph nodes are usually the sites that are most frequently affected, but no organ is spared and CS can affect a variable portion of SA patients, up to 25% from post-mortem studies. The cardiovascular involvement is usually associated with a bad prognosis and is responsible for the major cause of death and complications, particularly in African American patients. Furthermore, the diagnosis is often complicated by the occurrence of non-specific clinical manifestations, which can mimic the effect of more common heart disorders, and imaging and biopsies are the most valid approach to avoid misdiagnosis. This narrative review summarizes the main clinical features of CS and imaging findings, particularly of CMR and 18-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) that can give the best cost/benefit ratio in terms of the diagnostic approach. Imaging can be very useful in replacing the endomyocardial biopsy in selected cases, to avoid unnecessary, and potentially dangerous, invasive maneuvers.

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The Future of Cardiac Molecular Imaging

Cited by 24 publications

References 194 publications

New insight into biology, molecular diagnostics and treatment options of unstable carotid atherosclerotic plaque: a narrative review

New insight into biology, molecular diagnostics and treatment options of unstable carotid atherosclerotic plaque: a narrative review

Maintaining Success for Patients With Dilated Cardiomyopathy and Remission of Heart Failure

Clinical Features and Diagnosis of Cardiac Sarcoidosis

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