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. 2023 Feb;50(3):839-848.
doi: 10.1007/s00259-022-06015-0. Epub 2022 Nov 3.

[68Ga]Ga-DOTA-FAPI-04 PET/MR in patients with acute myocardial infarction: potential role of predicting left ventricular remodeling

Min Zhang  1   2 , Weiwei Quan  3 , Tianqi Zhu  3 , Shuo Feng  3 , Xinyun Huang  1   2 , Hongping Meng  1   2 , Run Du  3 , Zhengbin Zhu  3 , Xuezheng Qu  3 , Ping Li  3 , Yuke Cui  3 , Kuangyu Shi  4   5 , Xiaoxiang Yan  6 , Ruiyan Zhang  7 , Biao Li  8   9
Affiliations

[68Ga]Ga-DOTA-FAPI-04 PET/MR in patients with acute myocardial infarction: potential role of predicting left ventricular remodeling

Min Zhang et al. Eur J Nucl Med Mol Imaging. 2023 Feb.

Abstract

Purpose: To assess predictive value of 68Ga-labeled fibroblast activation protein inhibitor-04 ([68Ga]Ga-DOTA-FAPI-04) PET/MR for late left ventricular (LV) remodeling in patients with ST-segment elevated myocardial infarction (STEMI).

Methods: Twenty-six patients with STEMI were included in the study. [68Ga]Ga-DOTA-FAPI-04 PET/MR was performed at baseline and at average 12 months after STEMI. LV remodeling was defined as >10% increase in LV end-systolic volume (LVESV) from baseline to 12 months.

Results: The LV remodeling group demonstrated higher [68Ga]Ga-DOTA-FAPI-04 uptake volume (UV) at baseline than the non-LV remodeling group (p < 0.001). [68Ga]Ga-DOTA-FAPI-04 UV at baseline was a significant predictor (OR = 1.048, p = 0.011) for LV remodeling at 12 months after STEMI. Compared to clinical information, MR imaging and cardiac function parameters at baseline, [68Ga]Ga-DOTA-FAPI-04 UV demonstrated better predictive ability (AUC = 0.938, p < 0.001) for late LV remodeling, with sensitivity of 100.0% and specificity of 81.3%.

Conclusions: [68Ga]Ga-DOTA-FAPI-04 PET/MR is an effective tool to non-invasively quantify myocardial fibroblasts activation, and baseline [68Ga]Ga-DOTA-FAPI-04 UV may have potential predictive value for late LV remodeling.

Keywords: Acute myocardial infarction; Fibroblast activation protein inhibitor; Left ventricular remodeling; Myocardial fibrosis; PET/MR.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study Flow Chart. STEMI, ST-segment elevated myocardial infarction
Fig. 2
Fig. 2
Myocardial [68Ga]Ga-DOTA-FAPI-04 uptake intensity and volume at baseline. TBRmax (green triangle) and TBRmean (red square) as well as [68Ga]Ga-DOTA-FAPI-04 UV (blue circles) varied considerably between individuals. TBR: target-to-background ratio. UV: uptake volume
Fig. 3
Fig. 3
Representative [68Ga]Ga-DOTA-FAPI-04 PET/MR images in a patient with late LV remodeling and a patient with good cardiac functional outcomes. A In patient no. 6 (male, 66 years old, with RCA occlusion), large [68Ga]Ga-DOTA-FAPI-04 UV was observed at both baseline (251.3 cm3) and follow-up (229.3 cm3). More importantly, LVEDV and LVESV increased by 17.6% and 32.6%, respectively, and LVEF decreased by 28.6%, indicating adverse LV remodeling. Additionally, [68Ga]Ga-DOTA-FAPI-04 uptake was observed in the remote non-LGE area (red arrow). B Cardiac angiography showed an occlusion and a recanalization of a distal branch of RCA (red arrow) before and after PCI, suggesting microscopic myocardial infarction. C In patient no. 3 (male, 64 years old, with LAD occlusion), small [68Ga]Ga-DOTA-FAPI-04 UV (red arrow) at baseline (82.8 cm3) and follow-up (15.4 cm3) was observed. LVEDV and LVESV respectively decreased by 3.8% and 0.0% with follow-up 60% LVEF indicating good cardiac functional outcomes. LVEDV: left ventricular end-diastolic volume; LVESV: left ventricular end-systolic volume; LVEF: left ventricular ejection fraction; UV: uptake volume; LAD: left anterior descending coronary artery; RCA right coronary artery
Fig. 4
Fig. 4
Comparison of the changes in cardiac function parameters between the group with [68Ga]Ga-DOTA-FAPI-04 UV < 134.8 cm3 and the group with [68Ga]Ga-DOTA-FAPI-04 UV ≥ 134.80 cm3. There was significant difference of the change in A LVESV (p = 0.003) and B LVEDV (p = 0.007) as well as a tendency in difference of (C) LVEF (p = 0.052) between the two groups. LVEDV: left ventricular end-diastolic volume; LVESV: left ventricular end-systolic volume; LVEF: left ventricular ejection fraction; UV: uptake volume
Fig. 5
Fig. 5
The relationship between baseline [68Ga]Ga-DOTA-FAPI-04 UV and late LV remodeling. A The LV remodeling group demonstrated higher [68Ga]Ga-DOTA-FAPI-04 UV at baseline than the non-LV remodeling group (p < 0.001). B Compared to LGE volume, LGE%, LVEDV, LVESV, LVEF, and the extent of transmural infarction, [68Ga]Ga-DOTA-FAPI-04 UV at baseline showed the highest AUC (0.938) for predicting the LV remodeling, with optimal sensitivity of 100.0% and specificity of 81.3%. UV: uptake volume; LV: left ventricular; LGE: late gadolinium enhancement; LVEDV: left ventricular end-diastolic volume; LVESV: left ventricular end-systolic volume; LVEF: left ventricular ejection fraction
See this image and copyright information in PMC

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