Quantitative Molecular Imaging for Cardiovascular Phenotypes

More than 17 million deaths worldwide were attributed to heart disease in 2016, and cardiovascular ailments persistently remain one of the biggest causes of hospital admissions in the United States. Cardiovascular disease also accounts for more healthcare costs than any other chronic illness, and is responsible for one out of every three deaths, on average.

Finally, there is good news on the cardiac care front and it has to do with quantitative molecular imaging. This novel technology that emerged from discoveries made in the field of biology, allows noninvasive imaging of biochemical processes at the molecular and cellular level in vivo within the body.

Unlike conventional imaging that relies on visualizing late pathological consequences, the next decade will see quantitative molecular imaging regularly used to interrogate the very molecular events that drive so many heart disease processes.

Using biomarkers bioengineered with targeting and signaling components with low risk of toxicity, these sensitive and specific imaging probes will routinely be used to noninvasively pinpoint target molecules of interest within the heart and vasculature when paired with positron emission tomography, magnetic resonance imaging, ultrasound, computed tomography, or optical imaging.

The clinical benefits of quantitative molecular imaging are immense and many critical cardiac questions will be addressed with the targeted probes. The crucial role of imaging in early phenotyping of cardiovascular disease, risk assessment, and management guidance will expand rapidly in ways previously thought unrealistic. For example, by using targeted imaging of vascular inflammation or thrombosis, patients will benefit from improved assessment of atherosclerosis and the uncovering of plaques at high risk of causing accelerated and aggressive disease over the ensuing decades.

Quantitative molecular imaging will also be used for predicting very high risk in younger people in whom risk-lowering therapy is likely to be more beneficial. This matter is going to increase in importance with the introduction of newer, more potent, and very expensive anti-atherosclerotic therapies that may have more adverse effects than traditional statin therapy.

In the coming years, imaging probes will also be used to uncover myocardial apoptosis, metabolic alterations, and injury to the extracellular matrix, providing clinicians with critical information for assessing the risk of arrhythmias and left ventricular remodeling associated with heart failure and progressive cardiac dysfunction.

There’s also active research now in trying to determine whether a quantitative molecular imaging approach can help physicians decide which patients with low cardiac function will benefit most from an implantable cardioverter defibrillator therapy. Only about 1 percent of patients currently benefit from defibrillators. Not only are these devices very expensive, but they also pose additional potential morbidity from pre-exposing patients to infection if implanted wires start to fail.

With molecular imaging, however, physicians can improve patient care by accurately identifying those at greater risk of lethal arrhythmias and sudden cardiac death, thereby reducing the need for invasive medical devices and unnecessary surgical techniques for those who will not benefit from a defibrillator.

Since quantitative molecular imaging offers the promise of early disease detection and prediction of treatment response, this may lead to optimal therapies for each patient. In the next decade, this ability opens up new possibilities for realizing the dream of personalized medicine by moving from the one size fits all approach of yesterday to one that can deliver medical care specifically tailored to the needs of each patient based on their individual molecular status. This includes the detection of disease predisposition, earlier disease diagnosis and prognosis assessment, and measurement of drug efficacy.

By understanding the different cellular phenotypes that result from interactions between genes and the environment, precise treatments for cardiac care will be formulated to offer each patient the best therapy and a better chance for a healthy and longer life.

At last, the dream of lowering those 17 million annual deaths to cardiovascular disease may be realized.

For more information about Dr. DiCarli’s research, please contact Partners HealthCare Innovation by clicking here.