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68Ga-FAPI PET/CT for molecular assessment of fibroblast activation in right heart in pulmonary arterial hypertension: a single-center, pilot study

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Positron emission tomography (PET) imaging with radiolabeled fibroblasts activation protein inhibitor (FAPI) provides the opportunity to directly visualize fibrosis. This study aimed to investigate the feasibility of 68Ga-FAPI PET imaging in assessing right ventricular (RV) fibrotic remodeling and the relationship between FAPI uptake with parameters of pulmonary hemodynamics and cardiac function in pulmonary arterial hypertension (PAH) patients.

Methods

In this pilot study, sixteen PAH patients were enrolled to participate in cardiac 68Ga-FAPI PET/CT imaging. All patients underwent right heart catheterization and echocardiography for assessment of pulmonary hemodynamics and cardiac function within seven days. Cardiac FAPI uptake was visually assessed and quantified as maximum standardized uptake value (SUVmax).

Results

Twelve PAH patients exhibited FAPI uptake in RV free wall and insertion point. The overall activity of FAPI accumulated in the RV free wall (SUVmax: 2.5 ± 1.8, P < 0.001) and insertion point (SUVmax:2.5 ± 1.7, P < 0.001) was significantly upregulated compared to left ventricle (SUVmax:1.5 ± 0.5). Patients with tricuspid annular plane systolic excursion (TAPSE) < 17 mm presented significantly higher uptake than those with TAPSE ≥ 17 mm in both RV free wall (SUVmax: 3.4 ± 1.9 vs 1.7 ± 1.1, P = 0.010) and insertion point (SUVmax: 3.4 ± 1.9 vs 1.6 ± 0.7, P = 0.028), indicating RV uptake of FAPI was associated with RV dysfunction. There was significant positive correlation between cardiac FAPI uptake and total pulmonary resistance and the level of N-terminal pro b-type natriuretic peptide.

Conclusions

68Ga-FAPI PET/CT imaging is feasible to directly visualize fibrotic remodeling of RV in patients with PAH.

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Abbreviations

PAH:

Pulmonary arterial hypertension

RV:

Right ventricle/right ventricular

CMR:

Cardiac magnetic resonance

FAPI:

Fibroblast activation protein inhibitor

PET:

Positron emission tomography

TAPSE:

Tricuspid annular plane systolic excursion

FAC:

Fractional area change

PAP:

Pulmonary arterial pressure

PAWP:

Pulmonary artery wedge pressure

CO:

Cardiac output

NT-proBNP:

N-terminal pro b-type natriuretic peptide

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Acknowledgements

L.W. thanks for the support from Young Elite Scientists Sponsorship program by CAST (2018-QNRC001).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China

    Yufan Gu BS, Kai Han BS, Zongyao Zhang BS, Zuoquan Zhao PhD, Lei Wang MD & Wei Fang MD

  2. Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China

    Chaowu Yan MD

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  1. Yufan Gu BS
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  2. Kai Han BS
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  3. Zongyao Zhang BS
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  6. Lei Wang MD
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  7. Wei Fang MD
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Correspondence to Lei Wang MD.

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The work was supported by grants from National Natural Science Foundation of China (81801733).

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Gu, Y., Han, K., Zhang, Z. et al. 68Ga-FAPI PET/CT for molecular assessment of fibroblast activation in right heart in pulmonary arterial hypertension: a single-center, pilot study. J. Nucl. Cardiol. 30, 495–503 (2023). https://doi.org/10.1007/s12350-022-02952-3

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  • DOI: https://doi.org/10.1007/s12350-022-02952-3

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