Zheng Yaqi, Wang Yanlin, Zhang Xiaoli
Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Curr Cardiol Rep. 2025 Apr 11;27(1):83. doi: 10.1007/s11886-025-02230-x.
The diagnosis of light-chain cardiac amyloidosis (AL-CA) is often delayed owing to nonspecific clinical symptoms and comorbidities, making early detection and risk stratification essential for early intervention. Activated cardiac fibroblasts play a vital role in cardiac remodeling and cardiac damage progression, leading to heart failure. Emerging imaging modalities visualize fibroblast activation protein (FAP) as a marker of activated fibroblasts, enabling non-invasive and accurate measurement of cardiac remodeling for risk stratification. This review summarizes the status of diagnosis and treatment, pathogenic basis of AL-CA, and positron emission tomography (PET) imaging to assess the potential of gallium 68 (Ga)-labeled FAP inhibitor 04 (Ga-FAPI-04) for AL-CA diagnosis and treatment.
Ga-FAPI-04 PET/computed tomography (CT) can detect myocardial fibroblast activation in patients with AL-CA, with significant uptake observed in most patients. The degree of activation correlates with cardiac function, morphology, and serum markers, suggesting its utility in prognostic assessments. Ga-FAPI-04 PET/CT may enable more robust risk stratification and prognostic assessment than that via F-florbetapir PET/CT, underscoring the significance of cardiac fibroblast activation in predicting the outcomes of patients with AL-CA. Ga-FAPI-04 PET/CT has emerged as a promising tool for diagnosing AL-CA, offering insights into the molecular characteristics of the disease and aiding in clinical decision-making. Existing findings suggest the potential of Ga-FAPI-04 PET/CT for enhancing myocardial fibrosis management in AL-CA. Future multicenter trials are warranted to validate these findings and explore the integration of Ga-FAPI-04 PET/CT with other imaging modalities to improve the diagnosis and prognostic prediction of patients with AL-CA.
由于临床症状不特异和合并症，轻链型心脏淀粉样变（AL-CA）的诊断常常延迟，因此早期检测和风险分层对于早期干预至关重要。活化的心脏成纤维细胞在心脏重塑和心脏损伤进展中起关键作用，可导致心力衰竭。新兴的成像方式将成纤维细胞活化蛋白（FAP）可视化为活化成纤维细胞的标志物，能够对心脏重塑进行无创且准确的测量以进行风险分层。本综述总结了AL-CA的诊断和治疗现状、发病机制基础以及正电子发射断层扫描（PET）成像，以评估68镓（Ga）标记的FAP抑制剂04（Ga-FAPI-04）用于AL-CA诊断和治疗的潜力。
Ga-FAPI-04 PET/计算机断层扫描（CT）能够检测AL-CA患者的心肌成纤维细胞活化，大多数患者可见明显摄取。活化程度与心脏功能、形态和血清标志物相关，提示其在预后评估中的效用。与18F-氟贝他吡PET/CT相比，Ga-FAPI-04 PET/CT可能能够实现更可靠的风险分层和预后评估，强调了心脏成纤维细胞活化在预测AL-CA患者结局中的重要性。Ga-FAPI-04 PET/CT已成为诊断AL-CA的一种有前景的工具，可深入了解该疾病的分子特征并有助于临床决策。现有研究结果提示Ga-FAPI-04 PET/CT在加强AL-CA心肌纤维化管理方面的潜力。未来有必要开展多中心试验以验证这些发现，并探索将Ga-FAPI-04 PET/CT与其他成像方式相结合，以改善AL-CA患者的诊断和预后预测。
