Clinical Impacts in Cardiovascular Molecular Imaging: the Example of Cardiac Sympathetic Imaging in Heart Failure

With the current advances in genomics and proteomics, cardiovascular molecular imaging techniques such as PET and SPECT, in combination with other cardiac molecular imaging techniques, will identify new markers of disease activity and will play a central role in screening of patients, diagnosis, prognosis and patient management. The complexity of the development process of vulnerable atherosclerotic plaques provides an excellent example of the need for combined molecular imaging. Predicting outcome by molecular imaging of atherosclerotic plaques should offer new paradigms for the management of coronary artery disease. In cardiac neurotransmission, molecular imaging can offer insights and provide better understanding of pathophysiologic mechanisms and help to improve patient management, in particular in patients with heart failure or at risk of arrhythmias. A recent important advance in the area of cardiovascular molecular imaging is reporter gene imaging. The concept has been validated in animal models, where reporter genes are only expressed by living stem cells, offering a means to track stem cell survival. Reporter genes are passed on to daughter cells, making assessment of cell proliferation possible. Reporter gene imaging can be applied to a variety of stem cells or therapeutic genes of interest in stem cell or gene based therapy in cardiovascular medicine.