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Review
. 2023 May 18;15(5):1532.
doi: 10.3390/pharmaceutics15051532.

Tracers for Cardiac Imaging: Targeting the Future of Viable Myocardium

Carmela Nappi  1 , Mariarosaria Panico  2 , Maria Falzarano  1 , Carlo Vallone  1 , Andrea Ponsiglione  1 , Paolo Cutillo  1 , Emilia Zampella  1 , Mario Petretta  3 , Alberto Cuocolo  1
Affiliations
Review

Tracers for Cardiac Imaging: Targeting the Future of Viable Myocardium

Carmela Nappi et al. Pharmaceutics. .

Abstract

Ischemic heart disease is the leading cause of mortality worldwide. In this context, myocardial viability is defined as the amount of myocardium that, despite contractile dysfunction, maintains metabolic and electrical function, having the potential for functional enhancement upon revascularization. Recent advances have improved methods to detect myocardial viability. The current paper summarizes the pathophysiological basis of the current methods used to detect myocardial viability in light of the advancements in the development of new radiotracers for cardiac imaging.

Keywords: ischemic heart disease; new probes; nuclear medicine techniques; tracers; viable dysfunctional myocardium.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient with a large area (yellow arrows) of hypoperfused (82Rb PET/MR) and nonviable (18F-FDG PET/CT) myocardium in the inferolateral wall of the left ventricle corresponding to an MR pattern of late gadolinium enhancement (LGE) in the same region.
Figure 2
Figure 2
Patient with severe hypoperfusion and preserved metabolic activity in the apex and the apical segment of the anteroseptal region of the left ventricle by combined 82Rb/18F-FDG PET/CT cardiac imaging. Slice review (A) and polar maps (B) indicate a mismatch pattern that suggests the presence of hypoperfused but viable myocardium.
Figure 3
Figure 3
Patient with absent perfusion and no evidence of metabolic activity in the apex and the apical segment of the anteroseptal region of the left ventricle by combined 82Rb/18F-FDG PET/CT cardiac imaging. Slice review (A) and polar maps (B) indicate a match pattern that suggests the presence of necrotic myocardium. Analysis of tracer uptake is performed in 17 myocardial segments by use of a 5-point scoring system (from 0, normal uptake to 4, absence of detectable tracer uptake).
Figure 4
Figure 4
Example of dual isotope 123I-MIBG/99mTc-sestamibi imaging obtained with CZT camera in a patient with hypertension and dyslipidemia and heart failure. Tomographic images (first row 123I-MIBG, second row 99mTc-sestamibi) demonstrating innervation and perfusion defect on the inferior wall of the left ventricle with a total defect score (TDS) of 35.
See this image and copyright information in PMC

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