Predicting reverse remodeling following valve replacement in patients with valvular heart disease: a longitudinal...

Area of Science:

• Cardiovascular Imaging
• Molecular Imaging
• Cardiac Fibrosis

Background:

• Fibroblast activation in valvular heart disease (VHD) contributes to myocardial remodeling.
• Fibroblast activation protein inhibitor (FAPI) imaging can identify this activation.
• Monitoring reverse remodeling post-valve replacement is crucial.

Purpose of the Study:

• To explore serial FAPI imaging for monitoring reverse myocardial remodeling after valve replacement in VHD patients.
• To assess the feasibility and quantitative tracking of fibroblast activation dynamics.

Main Methods:

• 31 VHD patients underwent 99mTc-FAPI SPECT/CT and echocardiography before and after valve replacement.
• FAPI uptake quantified by SUVmax, TBRmax, and FAV.
• Echocardiography assessed left ventricular geometric parameters for remodeling.

Main Results:

• FAPI uptake was heterogeneous but correlated with N-terminal prohormone of brain natriuretic peptide and LV mass index.
• Repeat FAPI imaging showed significant reductions in TBRmax and FAV post-intervention.
• Lower baseline TBRmax was associated with complete reverse remodeling.

Conclusions:

• Serial 99mTc-FAPI SPECT/CT is feasible for tracking fibroblast activation dynamics post-valve replacement.
• Preprocedural FAPI imaging may predict the potential for complete reverse remodeling.