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Purpose <p>In patients with valvular heart disease (VHD), fibroblast activation induced by pressure or volume overload can be identified by molecular imaging with fibroblast activation protein inhibitor (FAPI). The study sought to explore the potential of serial FAPI imaging for monitoring the reverse myocardial remodeling triggered by valve replacement.</p> Methods <p>A cohort of 31 VHD patients scheduled for transcatheter or surgical valve replacement underwent <sup>99m</sup>Tc-FAPI SPECT/CT imaging and echocardiography. All patients repeated echocardiography and 22 of them completed repeat FAPI scans at 3-month follow-up. Cardiac FAPI uptake was quantified as maximum standardized uptake value (SUV<sub>max</sub>), maximum of myocardial-to-blood ratio (TBR<sub>max</sub>), and fibroblast activation volume (FAV). Myocardial remodeling patterns were evaluated through a comprehensive analysis of left ventricular geometric parameters derived from echocardiography.</p> Results <p>Myocardial FAPI uptake showed heterogeneous among VHD patients (range: SUV<sub>max</sub> 0.67–8.33; TBR<sub>max</sub> 1.13–7.50; FAV 0-597 mL). FAPI uptake significantly correlated with levels of circulating N-terminal prohormone of brain natriuretic peptide and left ventricle mass index before valve replacement. Following relief of overload, 22 patients who underwent repeat FAPI imaging demonstrated significant reductions in TBR<sub>max</sub> (3.31 [1.73–4.87] vs. 2.43 [1.63–4.23], <i>p</i> = 0.029) and FAV (31.5 [0-227] vs. 12.0 [0-144] mL, <i>p</i> = 0.004). Follow-up echocardiography revealed that 9 out of 31 patients transitioned to normal geometry from concentric or eccentric hypertrophy, achieving complete reverse remodeling. Multivariable regression suggested baseline FAPI uptake intensity TBR<sub>max</sub> significantly associated with complete reverse remodeling post-intervention after adjustment (OR: 0.288 [0.097–0.852], <i>p</i> = 0.024).</p> Conclusion <p><sup>99m</sup>Tc-FAPI SPECT/CT imaging is feasible to quantitatively track dynamics of fibroblast activation following valve replacement. Patients with lower preprocedural fibrotic activity identified by FAPI imaging may have greater potential for complete reverse remodeling.</p>

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Predicting reverse remodeling following valve replacement in patients with valvular heart disease: a longitudinal 99mTc-FAPI SPECT/CT imaging study

  • 期刊论文

  • 发表日期：

    2025年6月17日

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  • Ke Wang,
  • Min Song,
  • Hui Li,
  • Yufan Gu,
  • Kai Han,
  • Chaowu Yan,
  • Wei Fang,
  • Lei Wang

摘要

Purpose

In patients with valvular heart disease (VHD), fibroblast activation induced by pressure or volume overload can be identified by molecular imaging with fibroblast activation protein inhibitor (FAPI). The study sought to explore the potential of serial FAPI imaging for monitoring the reverse myocardial remodeling triggered by valve replacement.

Methods

A cohort of 31 VHD patients scheduled for transcatheter or surgical valve replacement underwent 99mTc-FAPI SPECT/CT imaging and echocardiography. All patients repeated echocardiography and 22 of them completed repeat FAPI scans at 3-month follow-up. Cardiac FAPI uptake was quantified as maximum standardized uptake value (SUVmax), maximum of myocardial-to-blood ratio (TBRmax), and fibroblast activation volume (FAV). Myocardial remodeling patterns were evaluated through a comprehensive analysis of left ventricular geometric parameters derived from echocardiography.

Results

Myocardial FAPI uptake showed heterogeneous among VHD patients (range: SUVmax 0.67–8.33; TBRmax 1.13–7.50; FAV 0-597 mL). FAPI uptake significantly correlated with levels of circulating N-terminal prohormone of brain natriuretic peptide and left ventricle mass index before valve replacement. Following relief of overload, 22 patients who underwent repeat FAPI imaging demonstrated significant reductions in TBRmax (3.31 [1.73–4.87] vs. 2.43 [1.63–4.23], p = 0.029) and FAV (31.5 [0-227] vs. 12.0 [0-144] mL, p = 0.004). Follow-up echocardiography revealed that 9 out of 31 patients transitioned to normal geometry from concentric or eccentric hypertrophy, achieving complete reverse remodeling. Multivariable regression suggested baseline FAPI uptake intensity TBRmax significantly associated with complete reverse remodeling post-intervention after adjustment (OR: 0.288 [0.097–0.852], p = 0.024).

Conclusion

99mTc-FAPI SPECT/CT imaging is feasible to quantitatively track dynamics of fibroblast activation following valve replacement. Patients with lower preprocedural fibrotic activity identified by FAPI imaging may have greater potential for complete reverse remodeling.