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Updated: Sep 26, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Non-invasive in vivo imaging of myocardial apoptosis and necrosis
Albert Flotats1, Ignasi Carrió
1Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Insights
Non-invasive imaging agents help identify myocardial necrosis and apoptosis, aiding diagnosis and treatment assessment for cardiovascular disorders. This review compares key imaging agents for assessing cardiac cell death.
Area of Science:
- Cardiology
- Nuclear Medicine
- Pathophysiology
Background:
- Myocardial necrosis is central to cardiovascular disorders, necessitating accurate identification and localization for diagnosis and management.
- Apoptosis, or programmed cell death, is increasingly recognized as an early component of myocardial damage, preceding necrosis.
- Traditional "hot spot imaging agents" like 99mTc-pyrophosphate and 111In-antimyosin have been used for myocardial infarction detection.
Purpose of the Study:
- To review and compare gamma imaging agents for non-invasively assessing myocardial necrosis and apoptosis.
- To highlight the evolving role of these agents beyond myocardial infarction detection in various cardiovascular conditions.
- To evaluate the characteristics and clinical utility of novel markers like 99mTc-annexin V.
Main Methods:
- Review of existing literature on gamma imaging agents for myocardial necrosis and apoptosis.
- Analysis of the performance of traditional agents (99mTc-pyrophosphate, 111In-antimyosin) and newer agents (99mTc-glucarate, 99mTc-annexin V).
- Comparison of agent characteristics for diagnosing myocardial infarction, transplant rejection, myocarditis, cardiotoxicity, and cardiomyopathies.
Main Results:
- Established agents like 99mTc-pyrophosphate and 111In-antimyosin are primarily used for myocardial infarction.
- Emerging agents, particularly 99mTc-annexin V, show promise for non-invasively imaging apoptosis in conditions like acute myocardial infarction and transplant rejection.
- 99mTc-glucarate has also demonstrated potential in preliminary studies.
Conclusions:
- Non-invasive imaging of myocardial necrosis and apoptosis is crucial for cardiovascular disease management.
- A range of gamma imaging agents exist, each with specific applications and evolving clinical roles.
- Further research into novel markers like 99mTc-annexin V can improve the assessment of cardiac cell death and related disorders.
Abstract:
Myocardial necrosis plays an important role in the pathogenesis of various cardiovascular disorders and can result from different myocardial insults. Its non-invasive identification and localisation therefore may help in the diagnosis of these disorders, as well as in prognosis and assessment of treatment response. Apoptosis, or programmed cell death, is important in the spectrum of myocardial damage since it is gradually becoming more apparent that cell death may begin as apoptosis and not as necrosis. First attempts to directly visualise the area of myocardial necrosis were based on recognition of myocardial infarction with "hot spot imaging agents" in patients with chest pain. Since then, the study of myocardial necrosis with gamma imaging agents has gone beyond the detection of myocardial infarction, and attempts have been made to diagnose other cardiovascular disorders associated with cardiac cell death such as heart transplant rejection, myocarditis, cardiotoxicity and cardiomyopathies. Traditionally, two hot spot imaging agents have been used for the detection of myocardial necrosis, (99m)Tc-pyrophosphate and (111)In-antimyosin. In addition, preliminary studies have demonstrated promising results with (99m)Tc-glucarate. Recently, (99m)Tc-annexin V has been successfully used for non-invasive gamma imaging of apoptosis after acute myocardial infarction, acute myocardial ischaemia, acute cardiac allograft rejection and malignant intracardiac tumours. This review article focusses on the characteristics of these different myocardial necrotic and apoptotic markers and compares their role in the assessment of myocardial damage.
