Imaging in inflammatory heart disease: from the past to current clinical practice.

T he human heart has been a fascinating organ throughout human history. The Greek philosopher Aristotle (384–322 BC) considered the human heart to be the most important organ of the body. In his belief, the human heart was “the seat of intelligence, motion and sensation”, while the other organs surrounding the heart only existed to cool the heart. A few centuries later, the Greek scholar Galen (129–216 AD) described the human heart as the source of the body’s innate heat and stated that “the heart is a hard flesh, not easily injured”. During the Renaissance, Leonardo da Vinci (1452–1519) stated that “the heart is of such density that fire can scarcely damage it.” Taken together, ancient scholars consistently believed that a) the human heart is an outstanding organ, and b) it is robust and can hardly be damaged. However, today cardiovascular diseases represent the number one cause of morbidity and mortality in western societies and we know that even a tiny pathogen like a virus can cause lethal damage to the heart. Amongst cardiac diseases, inflammatory heart disease is gaining increasing importance, since new imaging techniques enable the non-invasive detection of inflamed or “overheated” myocardium in various diseases. Only through an accurate diagnosis of myocardial inflammation can successful implementation of appropriate therapies be achieved. Therefore, this review will focus on imaging modalities currently used to detect myocardial inflammation, after briefly looking at the historical origins of inflammatory heart disease and related diagnostic techniques (Table 1).