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Advances in the identification and characterisation of coronary artery disease and cardiomyopathy

ESC Congress Report

  • PET/CT flow quantification in multivessel CAD.
  • PET/MRI in identification and characterization of myocardial tissue injury.
  • MRI and T1-mapping to non-invasively assess myocardial fibrosis in cardiomyopathy.
  • Nuclear techniques for myocardial receptor imaging.

View the Slides from this session in ESC Congress 365

A variety of cardiovascular imaging modalities are increasingly applied for research and clinical investigations. With the advent of the introduction of PET/CT and PET/MRI, cardiovascular imaging may allow a comprehensive identification and characterization of cardiovascular pathology and, moving forward to molecular imaging, may identify potential new targets in the prevention and/or treatment of cardiovascular disease.

Prof. Paul Knaapen (Amsterdam, NL) illustrated the increased use of non-invasively and PET-determined myocardial flow reserve (MFR) in the clinical field for the identification and characterization of CAD burden in multivessel disease. He outlined flow thresholds that may signify flow-limiting effects of each stenosed coronary vessel in multivessel disease, which may enable the interventional cardiologist and/or cardiovascular surgeon a more differentiated and individualized treatment approach for coronary revascularization.  The added prognostic value of an abnormal MFR was also discussed, which may reflect a target for preventive measures in CAD patients.

Prof. Markus Schwaiger (Munich, DE) summarized the outstanding potential of cardiac PET/MRI in signifying and characterizing tissue injury of the myocardium after myocardial infarction or in cardiomyopathy. Combining anatomic, functional, metabolic, and molecular imaging information with PET/MRI affords a comprehensive assessment of hibernating-stunning myocardium, the inflammatory, immunologic, and reparative mechanism in acute and chronic myocardial infarction model with associated remodelling of the left ventricle. Notably, PET/MRI may be most suitable in the identification of novel targets for the prevention and treatment of heart failure patients.

Prof. Eike Nagel (London, GB) provided an excellent and comprehensive overview of the use of cardiac MRI in concert with T1-mapping for the assessment of the extracellular myocardial space as surrogate marker of interstitial myocardial fibrosis, which carries important diagnostic and prognostic information and may be used in the clinical setting in the near future. This novel diagnostic approach may also aid in a better understanding of underlying pathology in heart failure patients with different origins.

Prof. Paolo Camici (Milano, IT) excellently summarized previous and recent development in receptor imaging of the heart with focus on cardiomyopathy and risk stratification. The use of various radiotracers such as I123-MIBG, 11C-HED, and 11C-CGP in cardiomyopathy patients and their clinical and prognostic value were discussed. Applying nuclear receptor imaging techniques with SPECT or PET are most helpful, for example,  in signifying impaired sympathetic innervations  and expression of B-blockers in the failing myocardium, which may aid the cardiologist in the decision-making process for various treatment options of heart failure patients and monitoring therapy.    




Advances in the identification and characterisation of coronary artery disease and cardiomyopathy

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.