Advances in Cardiovascular Imaging Multimodality Cardiovascular Molecular Imaging, Part I

There has been a shift in emphasis from treatment of disease to the primary or secondary prevention of disease, primarily to advance human health through preservation of quality of life and improvement in survival, but also in part to control the escalating costs of health care. The prevention of disease necessitates early detection and risk stratification before the manifestation of disease, which may be facilitated by genotyping, assessment of circulating biomarkers, or noninvasive imaging. Moreover, it is becoming increasingly apparent that the combination of an individual’s genotype, level of gene expression, and clinical information can be used for individualized disease prevention, risk stratification, and therapy, thus leading to more successful and efficient health care. Taken together, the new directions in health care present new challenges to both the basic research and clinical practice communities and involve technological adaptations and integration into novel diagnostic paradigms. Traditionally, the detection, evaluation, and prognostication of cardiovascular disease or therapeutic interventions were assessed by studying physiological consequences expressed in changes in flow, metabolism, and function or on the detection of late anatomic changes. The development of biologically targeted markers to genetic and cellular processes of disease and disease amelioration has become possible with advances in genomics and proteomics. The application of imaging using these biologically targeted markers (eg, molecular imaging) in preclinical models and the translation of these approaches to patients has become possible with advent of a number of technological advances. The application of molecular imaging may provide additional unique molecular and pathophysiological insight that will allow a more personalized approach to evaluation and management of cardiovascular disease. In this 2-part consensus article, the current state-of-the-art of cardiovascular molecular imaging will be reviewed. In Part I, the focus will be on the imaging methodology, evolving imaging technology, and the development of novel targeted molecular probes. The role of metabolic and neuroreceptor imaging will be reviewed, because these approaches represent the roots of molecular imaging within the cardiovascular system. Newer reporter gene and reporter probe imaging approaches for tracking of cardiac transgene expression will also be reviewed. Part II of this consensus article will summarize the available targeted imaging probes for identification and evaluation of critical pathophysiological processes of the cardiovascular system. These include novel imaging strategies for evaluation of processes like inflammation, thrombosis, apoptosis, necrosis, vascular remodeling, and angiogenesis. The second part will also review the role of targeted imaging of a host of interrelated diseases, including atherosclerosis, ischemic injury, postinfarction remodeling, and heart failure, as well as regenerative, genetic, or cellbased therapies. The second article will finally review the opportunities and challenges associated with the implementation and advancement of targeted molecular imaging in clinical practice for the realization of truly personalized medicine.