Medicine is advancing at a staggering pace. It is virtually impossible to read standard medical or cardiovascular journals without finding a substantial number of pages devoted to exciting genetic and molecular biological investigations relating to cardiovascular disease. Diseases are being defined and characterized in new terms and in new ways. One can no longer think only in terms of clinical, anatomical, or physiological paradigms. Rather, the entity can now be approached with respect to specific mutations of specific proteins. The molecular-knowledge explosion involving hypertrophic cardiomyopathy is a perfect example of our new understanding of disease. The ultimate goal of a new therapeutics based on genetic manipulation appears to be attainable. In short, with respect to science, we live in revolutionary times: the molecular and genetic era.
How does nuclear cardiology currently relate to this scientific era? Nuclear cardiology has excelled as a set of techniques to evaluate rigorously myocardial blood flow, perfusion, metabolism, and function. These techniques have been used to answer important and fundamental clinical questions. Nuclear cardiology has been used to pioneer the exploration and understanding of issues relating to efficacy, clinical outcomes, and cost-effectiveness. The nuclear cardiology report card would certainly receive an "A" in these clinical areas. The field has gotten its act together and is dealing effectively with the critical clinical issues we all face.
However, the report card would not find a comparable grade with respect to modern molecular innovation and future scientific growth. This apparent lack of molecular commitment must be remedied. We must look beyond our present concerns. The field should not abandon its current research strategies; rather, it must broaden them. Exciting and obvious molecular fronts that nuclear cardiology should now consider include genotypic definition of at-risk populations by using novel molecular imaging approaches; imaging strategies that allow definition of varying forms of cell death such as apoptosis; definition of the metabolic signatures of cardiac disease, with specific reference to heart muscle