Molecular imaging of myocardial necrosis: an updated mini-review

Acute myocardial infarction (AMI) remains the most severe and common cardiac emergency among various ischaemic heart diseases. Both unregulated (necrosis) and regulated (apoptosis, autophagy and necroptosis et al.) forms of cell death can occur during AMI. Non-invasive imaging of cardiomyocyte death represents an attractive approach to acquire insights into the pathophysiology of AMI, track the temporal and spatial evolution of MI, guide therapeutic decision-making, evaluate response to therapeutic intervention and predict prognosis. Although several forms of cell death have been identified during AMI, to date, only apoptosis- and necrosis-detecting probes compatible with currently available tomographic imaging modalities have been successfully developed for non-invasive visualisation of cardiomyocyte death. Myocardial apoptosis imaging has gained more attention because of its potential controllability while less attention has been paid to myocardial necrosis imaging. In our opinion, although cardiomyocyte necrosis is unsalvageable, imaging necrosis can play an important role in early diagnosis, risk stratification, prognostic prediction and guidance in therapeutic decision-making of AMI. In this mini-review, we summarise the updated advances achieved by us and others and discuss the challenges in the development of molecular imaging probes for visualisation of myocardial necrosis.