Abstract
Cardiovascular magnetic resonance (CMR) is an integral part in the diagnostic work-up of cardiac inflammatory diseases. In this context, superparamagnetic iron oxide-based contrast agents can provide additional diagnostic information regarding the assessment of myocardial infarction and myocarditis. After intravenous administration, these nanoparticles are taken up by activated monocytes and macrophages, which predominantly accumulate in regions associated with inflammation as was successfully shown in recent preclinical studies. Furthermore, first clinical studies with a new iron oxide-complex that was clinically approved for the treatment of iron deficiency anaemia recently demonstrated a superior diagnostic value of iron oxide nanoparticles compared to gadolinium-based compounds for imaging of myocardial inflammation in patients with acute myocardial infarction. In this article, we outline the basic features of superparamagnetic iron oxide-based contrast agents and review recent studies using such nanoparticles for cardiac imaging in case of acute myocardial infarction as well as acute myocarditis. Moreover, we highlight the translational potential of these agents and possible research applications with regard to imaging and therapy.
Highlights
Myocardial inflammation: cause and consequences Myocardial inflammation is associated with a broad spectrum of pathophysiological pathways and may eventually cause both severe structural and functional impairment of the heart muscle
Myocardial inflammation can be triggered by various stimuli – including myocardial infections caused by pathogens such as viruses – and myocardial ischemia due to coronary artery occlusion in case of acute myocardial infarction
This review focuses on the diagnostic value of iron oxide nanoparticles for myocardial inflammation imaging in case of myocardial infarction and myocarditis
Summary
Myocardial inflammation: cause and consequences Myocardial inflammation is associated with a broad spectrum of pathophysiological pathways and may eventually cause both severe structural and functional impairment of the heart muscle. Myocardial inflammation can be triggered by various stimuli – including myocardial infections caused by pathogens such as viruses – and myocardial ischemia due to coronary artery occlusion in case of acute myocardial infarction Such mechanisms may lead to myocardial necrosis and initiate subsequent appropriate as well as inadequate or excessive responses of the innate immune system. Bietenbeck et al Journal of Cardiovascular Magnetic Resonance (2015) 17:54 applied for diagnosing myocarditis include T2-weighted imaging sequences for the unspecific diagnosis of myocardial oedema and contrast-enhanced CMR (ceCMR) for the (again unspecific) diagnosis of necrosis and/or fibrosis both of which may be present in myocardial infarction or myocarditis [5]. – despite remaining predominantly intravascular – IONs represent promising tracers for inflammation Exploiting this feature and their superior magnetic properties, tracking and visualization of internalized IONs by appropriate CMR sequences have great potential in the assessment of inflammatory processes. Their use in targeted drug delivery, magnetofection, hyperthermia or ex vivo molecular diagnostics have been reported [16]
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