PET imaging in heart failure: the role of new tracers

Positron emission tomography (PET) myocardial perfusion imaging is being increasingly used for the detection of coronary artery disease. In the presence of significant left ventricle dysfunction, the assessment of myocardial ischemia and viability by PET plays a role in the identification of patients who may benefit from revascularization. In addition to these, new PET tracers may play a role in the assessment of underlying pathophysiology and therapeutic options in heart failure. Studies have shown the ability of sympathetic innervation imaging to assess the risk of cardiac death, arrhythmia, and disease progression. New tracers have been tested for the assessment of angiogenesis and other mechanisms involved in myocardial repair after infarction. Furthermore, new tracers may play a role in detection of inflammatory cardiomyopathies, especially cardiac sarcoidosis, which is a diagnostic challenge for current methods. In addition to the assessment of prognosis and etiology, the value of new PET tracers will depend on their ability to guide selection of therapies and incorporation into clinical management algorithms in heart failure. This review describes recent advances in applications of cardiac PET in heart failure with emphasis on potential roles of new tracers.