Abstract
Imaging myocardial angiogenesis presents a major technical challenge because the ideal spatial resolution required is substantially higher than that available with standard X-ray angiography and nuclear medicine imaging. Moreover, these clinical imaging methods are currently inadequate (because of insufficient resolution) for clinical trials of angiogenic agents for the treatment of ischemic heart disease. Specialized techniques in MRI, ultrasonography, echocardiography and CT that are under development might provide improved means of imaging myocardial angiogenesis. Molecular imaging technologies are also being developed to improve resolution and to provide a better mechanistic insight into angiogenic therapies for ischemic heart diseases. This Review examines advanced methods for imaging angiogenesis. These technologies might soon permit data to be obtained directly from scientific studies and clinical trials.
Key Points
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Progress has been made in imaging technologies to assess myocardial angiogenesis
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The development of molecular probes specific for different stages of angiogenesis might further improve the resolution of clinical imaging
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Two-photon emission microscopy is an excellent example of combining activated probes to examine subcellular processes in the myocardium in vivo
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Generation of molecular beacons for receptors, proteins and markers of angiogenesis conjugated to iron and gadolinium allows for even more accurate magnetic resonance imaging
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Objective imaging end points will limit placebo effects seen in patients with chronic ischemia when subjective clinical outcome measures such as angina and quality of life questionnaires are used
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Large-scale clinical studies should be undertaken using new imaging technologies with higher sensitivity and specificity
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Supplementary information
Supplementary Table 1
Spatial resolution of different imaging modalities (DOC 40 kb)
Supplementary Figure 1
Diagram of the multiple factors leading to production of new vessels (DOC 174 kb)
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Wykrzykowska, J., Henry, T., Lesser, J. et al. Imaging myocardial angiogenesis. Nat Rev Cardiol 6, 648–658 (2009). https://doi.org/10.1038/nrcardio.2009.157
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DOI: https://doi.org/10.1038/nrcardio.2009.157
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