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Functional significance of myocardial activity at 18F-FAPI PET/CT in hypertrophic cardiomyopathy identified by cardiac magnetic resonance feature-tracking strain analysis

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Abstract

Purpose

This study aimed to evaluate the functional significance of 18F-labeled fibroblast activation protein inhibitor (18F-FAPI) activity in hypertrophic cardiomyopathy (HCM) by comparison with cardiac magnetic resonance feature-tracking (CMR-FT) strain analysis.

Methods

A total of 49 HCM patients were included in this study. Two independent control groups of healthy participants with a matched age and sex to the HCM patients were also enrolled. Left ventricular (LV) 18F-FAPI activity was analyzed for extent (FAPI%) and intensity (maximum target-to-background ratio, TBRmax). The CMR tissue characterization parameters of the LV included late gadolinium enhancement, native T1 value, and extracellular volume fraction. LV strain analysis was performed in radial, circumferential, and longitudinal peak strains (PS).

Results

Intense LV myocardial 18F-FAPI uptake was observed in HCM patients, whereas no obvious uptake was detected in healthy participants (median TBRmax, 9.1 vs. 1.2, p < 0.001). The strain parameters of HCM patients, compared with healthy participants, were significantly impaired (mean radial PS, 23.5 vs. 36.0, mean circumferential PS, −14.5 vs. −20.0, and mean longitudinal PS, −9.9 vs. −16.0, all p < 0.001). At segmental levels, there was a moderate correlation between 18F-FAPI activity and strain parameters. The number of positive 18F-FAPI uptake segments (n = 653) was higher than that of hypertrophic segments (n = 190) and positive CMR tissue characterization segments (n = 525) (all p < 0.001). In segments with negative CMR tissue characterization findings, the strain capacity of positive 18F-FAPI uptake segments was lower than that of negative 18F-FAPI uptake segments (median radial PS, 30.5 vs. 36.1, p = 0.026 and median circumferential PS, −18.4 vs. −19.7, p = 0.041).

Conclusion

18F-FAPI imaging can partially reflect the potential strain reduction in HCM patients. 18F-FAPI imaging detects more involved myocardium than CMR tissue characterization techniques, and the additionally identified myocardium has impaired strain capacity.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Code availability

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Funding

This work was supported by the National Key Research and Development Program of China (2021YFF0501401, 2021YFF0501402, and 2021YFF0501400) and Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (ZYLX202105).

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Author notes

  1. Yu Zhang and Zhixiang Dong contributed equally to this work and are co-first authors.

  2. Shihua Zhao and Min-Fu Yang contributed equally to this work and are co-corresponding authors.

Authors and Affiliations

  1. Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Road, Chaoyang District, Beijing, 100020, China

    Yu Zhang, Li Wang, Bi-Xi Chen, Yao Su & Min-Fu Yang

  2. Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Zhixiang Dong & Shihua Zhao

  3. Department of Intensive Care Unit, Emergency General Hospital, Beijing, China

    Yi-Lu Wang

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Contributions

Yu Zhang, Zhixiang Dong, Shihua Zhao, and Min-Fu Yang wrote the draft of the manuscript; Li Wang and Yi-Lu Wang collected and analyzed the clinical data; Bi-Xi Chen and Yao Su analyzed the PET/CT data; Yu Zhang and Zhixiang Dong analyzed the CMR data; Yu Zhang, Zhixiang Dong, Li Wang, Shihua Zhao, and Min-Fu Yang conceived the study and interpreted the results. All authors contributed to the article’s revision, agreed to its submission, and had full access to original data.

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Correspondence to Min-Fu Yang.

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All procedures involving human participants were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the ethics committee of Beijing Chaoyang Hospital (2021-ke-387).

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data and photographs.

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Zhang, Y., Dong, Z., Wang, L. et al. Functional significance of myocardial activity at 18F-FAPI PET/CT in hypertrophic cardiomyopathy identified by cardiac magnetic resonance feature-tracking strain analysis. Eur J Nucl Med Mol Imaging 51, 110–122 (2023). https://doi.org/10.1007/s00259-023-06411-0

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