PET Imaging of Inflammation Predicts Recovery and Guides Therapy After Heart Attack

Acute myocardial infarction can trigger lasting heart damage, yet clinicians still lack reliable tools to identify which patients will regain function and which may develop heart failure. Inflammation plays a central role in determining how the heart heals, but conventional imaging captures only irreversible injury and not the dynamic immune response. Now, a new PET imaging approach allows physicians to quickly identify patients who are at risk for poor functional recovery after a heart attack.

In a study led by Hannover Medical School (Lower Saxony, Germany), a research team focused on a PET imaging strategy that visualizes CXCR4, a key inflammatory protein expressed after cardiac injury. Investigators conducted multimodal assessments that included CXCR4-targeted PET/CT, myocardial perfusion imaging, and cardiac MRI in 49 patients within the first week of a heart attack. Forty participants returned for follow-up MRI roughly eight months later to evaluate structural and functional outcomes.

The imaging analysis revealed that CXCR4 activity extended beyond the central infarct and into the surrounding border zone, aligning closely with later declines in left ventricular function. These findings, published in The Journal of Nuclear Medicine, demonstrate that early CXCR4 upregulation correlates with adverse remodeling, offering a mechanistic link between inflammation and long-term injury. This supports CXCR4-PET as a predictive marker in the critical post-infarction window.

The work highlights how targeting inflammation could refine patient stratification. Excessive inflammatory signaling may identify individuals who could benefit from emerging anti-inflammatory or reparative therapies to prevent progression toward heart failure. Researchers plan to explore how imaging-guided interventions might optimize treatment timing and personalize care based on each patient’s inflammatory profile.

"By including CXCR4-targeted PET, we can identify patients who exhibit excessive or prolonged inflammation which may predispose them to adverse remodeling and heart failure. Such information could, in the future, support risk stratification and guide emerging anti-inflammatory or reparative therapies in a precision medicine framework," said Johanna Diekmann, MD, lead investigator of the study. "What's more, this approach may ultimately facilitate image-guided therapeutic strategies, allowing nuclear medicine to play an active role in monitoring and optimizing interventions that modulate inflammation, repair, and regeneration after cardiac injury."

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