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68Ga-FAPI PET visualize heart failure: from mechanism to clinic

Wenyu Song1,2, Xiao Zhang3,4, ShuKun He2,5

  • 1Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

European Journal of Nuclear Medicine and Molecular Imaging
|October 21, 2022
PubMed

Insights

This study shows that 68Ga-FAPI PET imaging can detect active cardiac fibrosis in heart failure (HF). Early detection of fibroblast activation protein (FAP) expression may help guide HF treatment decisions.

Area of Science:

  • Cardiovascular Imaging
  • Molecular Imaging
  • Fibrosis Research

Background:

  • Heart failure (HF) is a progressive condition driven by cardiac remodeling and fibrosis.
  • Fibroblast activation protein (FAP) is a key marker of active fibroblasts involved in HF progression.
  • Accurate visualization of active cardiac fibrosis is crucial for understanding HF and guiding therapy.

Purpose of the Study:

  • To assess the feasibility of 68Ga-FAPI PET/CT for visualizing cardiac fibrosis and function changes in heart failure.
  • To investigate the dynamic changes in FAP expression and its correlation with cardiac remodeling in an HF model.
  • To explore the potential of 68Ga-FAPI PET in clinical heart failure assessment.

Main Methods:

  • An isoproterenol (ISO)-induced HF rat model was established with weekly echocardiography and 68Ga-FAPI PET/CT.
  • Animal studies included biodistribution, autoradiography, and histological analyses (H&E, FAP immunofluorescence, Masson's trichrome).
  • A preliminary clinical study involved seven HF patients undergoing 68Ga-FAPI and 13N-NH3 PET imaging.

Main Results:

  • In rats, 68Ga-FAPI uptake peaked early (day 7) and decreased as fibrosis and injury increased.
  • Histopathology showed minimal fibrosis despite high early FAP expression.
  • Clinical imaging revealed variable 68Ga-FAPI uptake in the myocardium, not directly correlating with perfusion (13N-NH3).

Conclusions:

  • 68Ga-FAPI uptake is high in early HF stages and diminishes as the disease progresses.
  • 68Ga-FAPI PET imaging shows potential for detecting active myocardial fibrosis.
  • Monitoring FAP expression via PET may aid in early treatment decisions for heart failure patients.
Abstract

Keywords:
68Ga-FAPIFAPHeart failureMyocardial fibrosisPET

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