镓标记的纤维连接蛋白激活肽（Ga-FAPI）PET/MR评估冠心病中的心肌纤维化和室壁运动异常

Evaluation of myocardial fibrosis and wall motion abnormality with Ga-FAPI PET/MR in coronary heart disease.

作者信息

Luo Rui, Zhao Zhenyu, Zhang Chuan, Li Ru-Shuai, Wang Yanrong, Meng Qingle, Ni Yudan, Wang Bolin, Li Lanhua, Feng Luan, Yang Rui, Xie Lin, Chen Xin, Zhang Ming-Rong, Wang Feng

机构信息

Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, 210006, China.

Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-Ku, Chiba, 263-8555, Japan.

出版信息

EJNMMI Res. 2025 Jul 21;15(1):89. doi: 10.1186/s13550-025-01246-2.

DOI:10.1186/s13550-025-01246-2

PMID:40690085

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12279661/

Abstract

BACKGROUND

To explore the characteristics of cardiac fibroblast activation protein inhibitor (FAPI) PET/MR in coronary heart disease (CHD) and its association with abnormal wall motion.

RESULTS

In this prospective study, participants with CHD after PCI (Percutaneous Coronary Intervention) underwent gallium 68 ( Ga)-labeled FAPI PET/MR imaging. FAP signal was quantified using standardized uptake values. Cardiac MRI yielded functional parameters and area of injury (MRI non-viable). Abnormal wall motion identified by myocardial strain analysis was evaluated using integrated analysis of late gadolinium enhancement (LGE) and FAP signal. The correlations between FAP signal and clinical parameters were explored. Forty-two participants were included and FAP signal was higher in left ventricle regional myocardium compared with remote normal areas (SUVmax, 5.0 ± 1.8 vs 1.2 ± 0.4; p < .001). In total, 432 segments (432/714, 60.50%) displayed impaired wall motion. In integrated analysis, the highest wall motion abnormality score was observed in the FAPI active/MRI non-viable group (11.0 ± 5.2). FAP signal was positively correlated with K time (SUVpeak: R = 0.48; p = .046; SUVmean: R = 0.57; p = .014) and negatively correlated with Angle (SUVpeak: R = - 0.52; p = .026; SUVmean: R = - 0.56; p = .026) in thromboelastography. Immunohistochemical analysis revealed FAP-positive fibroblasts in the infarct and border zone, and robust expression of α-smooth muscle actin and vimentin.

CONCLUSIONS

Simultaneous Ga- FAPI PET/MR offers novel insights into the regional pattern of fibroblast activation in CHD, and the fibroblast activation protein signal is associated with abnormal wall motion. Trial registration ClinicalTrials: ClinicalTrials.gov ID: NCT05867589. Registered 01 May 2023, https://clinicaltrials.gov/study/NCT05867589.

摘要

背景

探讨冠心病（CHD）中心脏成纤维细胞激活蛋白抑制剂（FAPI）PET/MR的特征及其与室壁运动异常的关系。

结果

在这项前瞻性研究中，接受经皮冠状动脉介入治疗（PCI）后的冠心病患者接受了68镓（⁶⁸Ga）标记的FAPI PET/MR成像。使用标准化摄取值对FAP信号进行定量。心脏磁共振成像（MRI）得出功能参数和损伤面积（MRI显示为无存活心肌）。通过延迟钆增强（LGE）和FAP信号的综合分析评估心肌应变分析确定的室壁运动异常。探讨了FAP信号与临床参数之间的相关性。纳入42名参与者，左心室局部心肌的FAP信号高于远离正常区域（SUVmax，5.0±1.8对1.2±0.4；p<0.001）。总共432个节段（432/714，60.50%）显示室壁运动受损。在综合分析中，FAPI活性/MRI无存活心肌组的室壁运动异常评分最高（11.0±5.2）。FAP信号与血栓弹力图中的K时间呈正相关（SUVpeak：R=0.48；p=0.046；SUVmean：R=0.57；p=0.014），与角度呈负相关（SUVpeak：R=-0.52；p=0.026；SUVmean：R=-0.56；p=0.026）。免疫组织化学分析显示梗死区和边缘区有FAP阳性成纤维细胞，α-平滑肌肌动蛋白和波形蛋白表达强烈。

结论

同时进行⁶⁸Ga-FAPI PET/MR为冠心病中成纤维细胞激活的区域模式提供了新的见解，且成纤维细胞激活蛋白信号与室壁运动异常有关。试验注册：ClinicalTrials.gov标识符：NCT05867589。于2023年5月1日注册，https://clinicaltrials.gov/study/NCT05867589 。