Emerging tracers for cardiac imaging: Innovations and clinical implications

Imaging of cardiovascular disease is undergoing profound growth and transformation as conventional imaging modalities are increasingly being augmented with molecular functional imaging with the desire to accelerate more specific diagnosis, better quantify disease burden and prognosis, and ultimately provide more effective treatments and measures of success. Positron emission tomography (PET) with novel tracers can now target and image many molecular markers of various cardiovascular diseases, providing insight into changes in myocardial perfusion, fibrosis, metabolism, innervation, tissue repair, and inflammation that often proceeds irreversible structural changes and offers the opportunity for earlier and more targeted intervention via conventional therapy and theranostics concepts. Further, continued technologic advances in PET scanner technology and processing/quantification software (including artificial intelligence) further advances the utility of novel PET radiotracers by allowing for improved image quality and quantification, while reducing acquisition times and doses. While the future is exciting, much work needs to be done to identify and translate the most promising radiotracers to address the many unmet imaging needs of clinical cardiovascular practice.