title: Molecular imaging of the cardiac extracellular matrix.
abstract: In almost all cardiac diseases, an increase in extracellular matrix (ECM) deposition or fibrosis occurs, mostly consisting of collagen I. Whereas replacement fibrosis follows cardiomyocyte loss in myocardial infarction, reactive fibrosis is triggered by myocardial stress or inflammatory mediators and often results in ventricular stiffening, functional deterioration, and development of heart failure. Given the importance of ECM deposition in cardiac disease, ECM imaging could be a valuable clinical tool. Molecular imaging of ECM may help understand pathology, evaluate impact of novel therapy, and may eventually find a role in predicting the extent of ECM expansion and development of personalized treatment. In the current review, we provide an overview of ECM imaging including the assessment of ECM volume and molecular targeting of key players involved in ECM deposition and degradation. The targets comprise myofibroblasts, intracardiac renin-angiotensin axis, matrix metalloproteinases, and matricellular proteins.
authors.affiliation: From Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (H.J.d.H., V.F., J.N.); Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, the Netherlands (H.J.d.H.); Centre for Inherited Cardiovascular Diseases, IRCCS Policlinico San Matteo, Pavia, Italy (E.A.); Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (V.F.); and Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA (C.M.K.).
authors.forename: Hans J
authors.initials: HJ
authors.lastname: de Haas
authors.forename: Eloisa
authors.initials: E
authors.lastname: Arbustini
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Kramer
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
mesh_terms: D000818:Animals; D057791:Cardiac Imaging Techniques; D005109:Extracellular Matrix / Q000378:metabolism* / Q000473:pathology* / Q000648:ultrastructure; D016326:Extracellular Matrix Proteins / Q000378:metabolism*; D005355:Fibrosis / Q000378:metabolism / Q000473:pathology; D006331:Heart Diseases / Q000378:metabolism* / Q000473:pathology*; D006801:Humans; D058628:Myofibroblasts / Q000378:metabolism / Q000473:pathology
chemical_list: D016326:Extracellular Matrix Proteins
keywords: fibrosis; heart failure; molecular imaging; myofibroblasts