Detection of viral myocardial perfusion and viability disorders using molecular imaging

According to Rosstat statistics, ischemic heart disease (IHD) is currently one of the most common causes of disability and mortality in the Russian Federation. In some cases, the development of IHD is associated with damage to the myocardium and endothelial cells by viral agents such as parvovirus B19, HIV infection, SARS-CoV-2, etc. In the diagnosis of IHD, medical history data, laboratory and instrumental studies are used, including ECG, echocardiography, and assessment of CT myocardial perfusion. Of particular importance are methods for detecting hemodynamically significant coronary artery stenoses that require surgical myocardial revascularization. The "gold standard" for determining such stenoses is coronary angiography (CAG), which is associated with a number of complications, and therefore should be performed only if indicated. Molecular imaging techniques (SPECT and PET/CT of the myocardium) can be used to determine indications for CAG. Radionuclide diagnostic methods can be very effective in assessing myocardial perfusion and cardiomyocyte viability. Unlike CT perfusion of the myocardium, these methods do not require the use of drugs that can cause nephropathy or allergic reactions. However, it should be borne in mind that with the viral etiology of coronary heart disease, there is a possibility of misinterpreting the foci of inflammation associated with infection as a hibernated myocardium. Radionuclide methods make it possible to detect active calcification and inflammation zones in atherosclerotic plaques, which, in turn, contributes to a more accurate stratification of the risk of cardiovascular complications in coronary heart disease. This review examines various ways of using molecular imaging techniques for the diagnosis of coronary heart disease, including in the virus-associated form. Special attention is paid to the main radiopharmaceuticals that are already used in clinical practice, as well as promising developments in this field.