Department of Cardiology, Cardiovascualr Imaging Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Nuclear Medicine, Cardiovascualr Imaging Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
J Nucl Cardiol. 2024 Aug;38:101910. doi: 10.1016/j.nuclcard.2024.101910. Epub 2024 Jul 14.
Despite improved treatments for acute myocardial infarction (AMI), myocardial fibrosis remains a key driver of adverse left ventricular (LV) remodeling and increased mortality. Fibroblast activation and proliferation significantly contribute to this process by enhancing cardiac fibrosis, which can lead to detrimental changes in LV structure. This study evaluates the effectiveness of Tc-labeled fibroblast activation protein inhibitor (Tc-HFAPi) SPECT imaging in predicting LV remodeling over 12 months in post-AMI patients.
A cohort of 58 AMI patients (46 males, median age 61 [53, 67] years) underwent baseline Tc-HFAPi imaging (5 ± 2 days post-MI), perfusion imaging (6 ± 2 days post-MI), and echocardiography (2 ± 2 days post-MI). Additionally, 15 patients had follow-up Tc-HFAPi and perfusion imaging, while 30 patients had follow-up echocardiography. Myocardial Tc-HFAPi activity was assessed at the patient level. LV remodeling was defined as a ≥10% increase in LV end-diastolic diameter (LVEDD) or LV end-systolic diameter (LVESD) from baseline to follow-up echocardiography.
AMI patients displayed localized but non-uniform Tc-HFAPi uptake, exceeding perfusion defects. Baseline Tc-HFAPi activity exhibited significant correlations with BNPmax, LDHmax, cTNImax, and WBCmax, inversely correlating with LVEF. After 12 months, 11 patients (36.66%) experienced LV remodeling. Univariate regression analysis demonstrated an association between baseline Tc-HFAPi uptake extent and LV remodeling (OR = 2.14, 95%CI, 1.04, 4.39, P = 0.038).
Tc-HFAPi SPECT imaging holds promise in predicting LV remodeling post-MI, providing valuable insights for patient management and prognosis.
尽管急性心肌梗死（AMI）的治疗方法有所改善，但心肌纤维化仍然是导致左心室（LV）重构和死亡率增加的关键因素。成纤维细胞的激活和增殖通过增强心脏纤维化显著促进了这一过程，从而导致 LV 结构的不利变化。本研究评估了 Tc 标记的成纤维细胞激活蛋白抑制剂（Tc-HFAPi）SPECT 成像在预测 AMI 后 12 个月 LV 重构中的有效性。
58 名 AMI 患者（46 名男性，中位年龄 61 [53，67] 岁）接受了基线 Tc-HFAPi 成像（MI 后 5 ± 2 天）、灌注成像（MI 后 6 ± 2 天）和超声心动图（MI 后 2 ± 2 天）。此外，15 名患者进行了随访 Tc-HFAPi 和灌注成像，30 名患者进行了随访超声心动图。在患者水平评估心肌 Tc-HFAPi 活性。LV 重构定义为与基线超声心动图相比，LV 舒张末期直径（LVEDD）或 LV 收缩末期直径（LVESD）增加≥10%。
AMI 患者显示出局部但不均匀的 Tc-HFAPi 摄取，超过了灌注缺损。基线 Tc-HFAPi 活性与 BNPmax、LDHmax、cTNImax 和 WBCmax 显著相关，与 LVEF 呈负相关。12 个月后，11 名患者（36.66%）发生 LV 重构。单因素回归分析显示，基线 Tc-HFAPi 摄取程度与 LV 重构之间存在相关性（OR=2.14，95%CI，1.04，4.39，P=0.038）。
Tc-HFAPi SPECT 成像有望预测 MI 后 LV 重构，为患者管理和预后提供有价值的信息。
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