Zhang Yuji, Chen Yufeng, Guo Jia, Xin Fangran, Liang Ming, Yin Zongtao, Han Jinsong, Zhao Keyan, Zhang Jian, Liu Guannan, Zhang Guoxu, Wang Zulu, Benditt David G, Po Sunny S, Wang Huishan
Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
Department of Nuclear Medicine, General Hospital of Northern Theater Command, Shenyang, Liaoning, China.
JACC Cardiovasc Imaging. 2025 Jun 12. doi: 10.1016/j.jcmg.2025.03.013.
The path from paroxysmal to persistent atrial fibrillation (AF) is still poorly understood, leading to suboptimal treatment outcomes.
In this study, the authors sought to investigate the level of fibrosis in different stages of AF with the use of F-labeled aluminum fluoride (AlF) targeting fibroblast activation protein inhibitor (FAPI) positron emission tomography (PET)-magnetic resonance imaging (MRI).
A total of 78 patients with AF and 49 health volunteers were enrolled in this study. All participants received FAPI-PET-MRI. Measurement of positive ratios and the proportion was performed in various regions of the left atrium posterior wall (LAPW), the atrial septum, anterior wall, appendage, and roof. Patients were categorized into paroxysmal (PAF), persistent (PsAF), and permanent (PmAF) AF groups based on 7-day ambulatory monitoring and history. Another cohort of 36 patients undergoing cardiac surgery, with 124 fragments of image-guided tissue, consented to biopsy during cardiac surgery for histology examinations.
The positive ratio for fibrosis was significantly higher in the PsAF and PmAF groups compared with the PAF and healthy volunteer groups across all atrial regions (P < 0.05). The LAPW showed the highest level of fibrosis. The AUC for the positive ratio was 0.991 to differentiate PAF from PsAF in the LA (cutoff: 0.072), and 0.983 in the LAPW (cutoff: 0.025). Between PsAF and PmAF, the AUC was 0.756 in the LA (cutoff: 0.382). Histologic analysis demonstrated an increased area of fibrotic deposition in regions with increased F-FAPI uptake.
LAPW fibrosis may be an important factor in the progression from PAF to PsAF. (A Single-Center, Prospective, Cohort Study on the Clinical Application of F-FAPI PET Imaging in Atrial Fibrillation; ChiCTR2300075806).
阵发性房颤（AF）向持续性房颤转变的机制仍未完全明确，导致治疗效果欠佳。
在本研究中，作者旨在利用靶向成纤维细胞活化蛋白抑制剂（FAPI）的F标记氟化铝（AlF）正电子发射断层扫描（PET）-磁共振成像（MRI），研究房颤不同阶段的纤维化程度。
本研究共纳入78例房颤患者和49名健康志愿者。所有参与者均接受FAPI-PET-MRI检查。在左心房后壁（LAPW）、房间隔、前壁、心耳和房顶的各个区域进行阳性率和比例的测量。根据7天动态监测和病史，将患者分为阵发性房颤（PAF）、持续性房颤（PsAF）和永久性房颤（PmAF）组。另一组36例接受心脏手术的患者，有124个影像引导下的组织碎片，同意在心脏手术期间进行活检以进行组织学检查。
在所有心房区域，PsAF组和PmAF组的纤维化阳性率显著高于PAF组和健康志愿者组（P<0.05）。LAPW的纤维化程度最高。LA中阳性率的曲线下面积（AUC）为0.991，用于区分PAF和PsAF（临界值：0.072），LAPW中为0.983（临界值：0.025）。在PsAF和PmAF之间，LA中的AUC为0.756（临界值：0.382）。组织学分析表明，F-FAPI摄取增加的区域纤维化沉积面积增加。
LAPW纤维化可能是PAF进展为PsAF的重要因素。（一项关于F-FAPI PET成像在房颤临床应用的单中心、前瞻性、队列研究；ChiCTR2300075806）
