Pathophysiology of myocardial injury and remodeling: implications for molecular imaging

Despite advances in reperfusion therapy, acute coronary syndromes can still result in myocardial injury and subsequent myocardial infarction (MI). Molecular, cellular, and interstitial events antecedent to the acute MI culminate in deleterious changes in the size, shape, and function of the left ventricle (LV), collectively termed LV remodeling. Three distinct anatomic and physiologic LV regions can be described after MI: the infarct, border zone, and remote regions. Given the complexity of post-MI remodeling, imaging modalities must be equally diverse to elucidate this process. The focus of this review will first be on cardiovascular MRI of the anatomic and pathophysiologic LV regions of greatest interest with regard to the natural history of the post-MI remodeling process. This review will then examine imaging modalities that provide translational and molecular insight into burgeoning treatment fields for the attenuation of post-MI remodeling, such as cardiac restraint devices and stem cell therapy.