Cardiovascular Molecular Imaging Focus on Clinical Translation

Significant technological developments in the field of molecular imaging over the past 2 decades have made molecular imaging a clinically feasible tool for the interrogation of important disease-related molecular events in a wide spectrum of clinical conditions ranging from atherosclerosis to advanced heart failure. As demonstrated in this review, molecular imaging has the potential to detect vulnerable plaques before the clinical manifestation of coronary artery disease to guide early intervention; assess the severity and prognosis of CHF via sympathetic innervation and glucose metabolism to help identify patient subpopulations who are more suitable for specific treatments (eg, implantable cardioverter defibrillator and CRT); study postischemia cardiomyocyte apoptosis and postinfarction repair so that therapeutic strategies can be designed to prevent ventricular remodeling and heart failure; and monitor novel stem cell therapies to both predict treatment outcomes and guide therapy. As molecular imaging techniques continue to be translated into the clinical setting, future efforts will focus on standardizing existing imaging protocols for particular applications (eg, 123I-MIBG imaging) to facilitate comparison across studies, developing generalizable platforms by which molecular imaging probes can be either screened or tailored for optimal pharmacodynamics or pharmacokinetics, exploring the combined use of different imaging modalities to utilize the strength of each technique (eg, PET/MRI), and combining molecular imaging assays with highly sensitive serum-based assays to maximize the sampling of relevant disease-specific biomarkers (secretory and nonsecretory) and to improve their sensitivity and predictability. The proper implementation of these measures will help propel molecular imaging to the forefront of clinical cardiology, where diagnostic imaging continues to be crucial for effective day-to-day patient management. Copyright © 2011 American Heart Association. All rights reserved.