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Objectives <p>Fibroblast activation protein (FAP)-targeted PET/CT can visualize activated fibroblasts, offering us the opportunity to identify myocardial fibrosis at an early stage. We aimed to establish a preliminary mapping of [<sup>68</sup>Ga]Ga-FAPI PET/CT in patients with non-ischemic cardiomyopathy (NICM), and to explore the correlation between myocardial FAPI uptake and cardiac function.</p> Methods <p>Fifty patients with different subtypes of NICM were enrolled. All patients underwent [<sup>68</sup>Ga]Ga-FAPI-04 PET/CT. A positive PET scan was defined as increased left ventricular (LV) FAPI activity than blood pool. LV molecular volume (LVMV), SUVr and SUVmean were calculated using a semi-automatic quantification method. The correlations between FAPI-uptake values and ventricular function were analyzed.</p> Results <p>Among all patients, 64% (32/50) exhibited a positive PET scan, with 16 patients demonstrating with patchy uptake and another 16 patients displaying with extensive uptake. LVMV, SUVr, and SUVmean were significantly higher in patients with extensive uptake than those with patchy uptake [LVMV, 254.5 (107.7–404.0) vs. 20.9 (4.5–31.3), <i>p</i> &lt; 0.0001; SUVr, 4.7 (3.2–6.7) vs. 2.3 (2.0–3.0), <i>p</i> = 0.0003; SUVmean, 2.8 (2.2–3.5) vs. 2.1 (1.6–2.4), <i>p</i> = 0.0147]. Notably, [<sup>68</sup>Ga]Ga-FAPI uptake values significantly correlated with N-terminal pro–brain natriuretic peptide (NT-proBNP), and abnormal LV contractile function assessed by echocardiography, including LV ejection fraction, LV end-diastolic dimension, and LV end-diastolic dimension (<i>p</i> &lt; 0.05). In subgroup analysis focusing on patients with dilated cardiomyopathy (<i>n</i> = 13), the correlation between [<sup>68</sup>Ga]Ga-FAPI uptake and echocardiographic parameters was also observed (<i>p</i> &lt; 0.05).</p> Conclusions <p>[<sup>68</sup>Ga]Ga-FAPI PET/CT demonstrated diverse myocardial fibroblast activation in NICM, which correlated with impaired ventricular contractile function and elevated NT-proBNP levels. These findings highlight its potential as a valuable imaging tool for early disease detection and risk stratification in NICM.</p>

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Fibroblast activation protein-targeted PET/CT in multiple non-ischemic cardiomyopathies

  • 期刊论文

  • 发表日期：

    2025年6月12日

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  • Qiao Yang,
  • Song Xue,
  • Chao Ren,
  • Xue Lin,
  • Marcus Hacker,
  • Wei Chen,
  • Na Niu,
  • Xiang Li,
  • Li Huo

摘要

Objectives

Fibroblast activation protein (FAP)-targeted PET/CT can visualize activated fibroblasts, offering us the opportunity to identify myocardial fibrosis at an early stage. We aimed to establish a preliminary mapping of [68Ga]Ga-FAPI PET/CT in patients with non-ischemic cardiomyopathy (NICM), and to explore the correlation between myocardial FAPI uptake and cardiac function.

Methods

Fifty patients with different subtypes of NICM were enrolled. All patients underwent [68Ga]Ga-FAPI-04 PET/CT. A positive PET scan was defined as increased left ventricular (LV) FAPI activity than blood pool. LV molecular volume (LVMV), SUVr and SUVmean were calculated using a semi-automatic quantification method. The correlations between FAPI-uptake values and ventricular function were analyzed.

Results

Among all patients, 64% (32/50) exhibited a positive PET scan, with 16 patients demonstrating with patchy uptake and another 16 patients displaying with extensive uptake. LVMV, SUVr, and SUVmean were significantly higher in patients with extensive uptake than those with patchy uptake [LVMV, 254.5 (107.7–404.0) vs. 20.9 (4.5–31.3), p < 0.0001; SUVr, 4.7 (3.2–6.7) vs. 2.3 (2.0–3.0), p = 0.0003; SUVmean, 2.8 (2.2–3.5) vs. 2.1 (1.6–2.4), p = 0.0147]. Notably, [68Ga]Ga-FAPI uptake values significantly correlated with N-terminal pro–brain natriuretic peptide (NT-proBNP), and abnormal LV contractile function assessed by echocardiography, including LV ejection fraction, LV end-diastolic dimension, and LV end-diastolic dimension (p < 0.05). In subgroup analysis focusing on patients with dilated cardiomyopathy (n = 13), the correlation between [68Ga]Ga-FAPI uptake and echocardiographic parameters was also observed (p < 0.05).

Conclusions

[68Ga]Ga-FAPI PET/CT demonstrated diverse myocardial fibroblast activation in NICM, which correlated with impaired ventricular contractile function and elevated NT-proBNP levels. These findings highlight its potential as a valuable imaging tool for early disease detection and risk stratification in NICM.