Molecular imaging targets of cardiac remodeling

Left ventricular (LV) remodeling is a major determinant of the clinical course and outcome of systolic heart failure (HF). Activation of neurohormonal and inflammatory cytokine pathways and their effects on intracellular signal transduction cascades through stimulation of membrane-bound receptors mediate LV remodeling. Although major advances have been made in clinical management of HF through large randomized trials, its prognosis remains poor. Interindividual differences, often genetically based, are increasingly recognized as important determinants of LV remodeling. Identification of the influence of these individual factors on the clinical course of HF has stimulated a search for specific pathophysiologic mechanisms that operate at the individual level and can be targeted directly. This article summarizes the current application of molecular imaging techniques to the understanding of the cellular and molecular mechanisms involved in LV remodeling in an attempt to provide the tools necessary for personalized, truly “evidence-based” assessment, serial evaluation, and monitoring of HF.