Xuezhu Wang, Kaini Shen, Yuke Zhang, Yajuan Gao, Bowei Liu, Yubo Guo, Chao Ren, Zhenghai Huang, Xiao Li, Long Chang, Haiyan Ding, Hui Zhang, Zhuang Tian, Marcus Hacker, Shuyang Zhang, Yining Wang, Jian Li, Xiang Li, Li Huo
{"title":"用18F-Florbetapir和68Ga-FAPI-04进行轻链心脏淀粉样变性的分子分层以提高预后精度。","authors":"Xuezhu Wang, Kaini Shen, Yuke Zhang, Yajuan Gao, Bowei Liu, Yubo Guo, Chao Ren, Zhenghai Huang, Xiao Li, Long Chang, Haiyan Ding, Hui Zhang, Zhuang Tian, Marcus Hacker, Shuyang Zhang, Yining Wang, Jian Li, Xiang Li, Li Huo","doi":"10.1016/j.jcmg.2024.10.001","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cardiac involvement in amyloid light chain (AL) amyloidosis significantly influences prognosis, necessitating timely diagnosis and meticulous risk stratification.</p><p><strong>Objectives: </strong>This prospective study aimed to delineate the molecular phenotypes of AL cardiac amyloidosis (AL-CA) by characterizing fibro-amyloid deposition using <sup>18</sup>F-florbetapir and gallium-68-labeled fibroblast activation protein inhibitor-04 (<sup>68</sup>Ga-FAPI-04) positron emission tomography (PET)/computed tomography (CT) imaging. The authors also proposed a novel molecular stratification methodology for prognosis.</p><p><strong>Methods: </strong>Patients with confirmed AL-CA underwent echocardiography and <sup>18</sup>F-florbetapir and <sup>68</sup>Ga-FAPI-04 PET/CT imaging. Cardiac amyloid burden was quantified as <sup>18</sup>F-florbetapir cardiac amyloid volume and total cardiac amyloid. Meanwhile, cardiac fibroblast activation protein (FAP) was quantified as <sup>68</sup>Ga-FAPI-04 cardiac FAP volume (CFV) and total cardiac FAP (TCF). PET/CT metrics were calculated in correlation to clinical and echocardiographic markers and their association with overall survival (OS) evaluated.</p><p><strong>Results: </strong>Among the 38 patients enrolled (median age: 58 years; 76.3% male), all patients exhibited amyloid deposition, and 86.8% (33 of 38) patients exhibited cardiac fibroblast activation. Cardiac amyloid burden was correlated with Mayo stage and several echocardiography metrics (P < 0.05). In addition, there was a correlation between CFV and N-terminal pro-B-type natriuretic peptide level (P < 0.05). Thirteen deaths occurred over a median follow-up of 24.8 months. Higher CFV and TCF were associated with shortened OS, particularly in Mayo stage III. In multivariable analysis, higher TCF was a primary determinant for shortened OS.</p><p><strong>Conclusions: </strong>The study underscores that higher TCF on <sup>68</sup>Ga-FAPI-04 PET/CT imaging might be a correlated factor of worse clinical outcome in newly diagnosed AL-CA, and this metric seems to be a molecular imaging tool complementary to <sup>18</sup>F-florbetapir imaging. The combination might offer a holistic understanding of molecular attributes, assisting in clinical decision-making.</p>","PeriodicalId":14767,"journal":{"name":"JACC. 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The authors also proposed a novel molecular stratification methodology for prognosis.</p><p><strong>Methods: </strong>Patients with confirmed AL-CA underwent echocardiography and <sup>18</sup>F-florbetapir and <sup>68</sup>Ga-FAPI-04 PET/CT imaging. Cardiac amyloid burden was quantified as <sup>18</sup>F-florbetapir cardiac amyloid volume and total cardiac amyloid. Meanwhile, cardiac fibroblast activation protein (FAP) was quantified as <sup>68</sup>Ga-FAPI-04 cardiac FAP volume (CFV) and total cardiac FAP (TCF). PET/CT metrics were calculated in correlation to clinical and echocardiographic markers and their association with overall survival (OS) evaluated.</p><p><strong>Results: </strong>Among the 38 patients enrolled (median age: 58 years; 76.3% male), all patients exhibited amyloid deposition, and 86.8% (33 of 38) patients exhibited cardiac fibroblast activation. Cardiac amyloid burden was correlated with Mayo stage and several echocardiography metrics (P < 0.05). In addition, there was a correlation between CFV and N-terminal pro-B-type natriuretic peptide level (P < 0.05). Thirteen deaths occurred over a median follow-up of 24.8 months. Higher CFV and TCF were associated with shortened OS, particularly in Mayo stage III. In multivariable analysis, higher TCF was a primary determinant for shortened OS.</p><p><strong>Conclusions: </strong>The study underscores that higher TCF on <sup>68</sup>Ga-FAPI-04 PET/CT imaging might be a correlated factor of worse clinical outcome in newly diagnosed AL-CA, and this metric seems to be a molecular imaging tool complementary to <sup>18</sup>F-florbetapir imaging. The combination might offer a holistic understanding of molecular attributes, assisting in clinical decision-making.</p>\",\"PeriodicalId\":14767,\"journal\":{\"name\":\"JACC. 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Molecular Stratification of Light-Chain Cardiac Amyloidosis With 18F-Florbetapir and 68Ga-FAPI-04 for Enhanced Prognostic Precision.
Background: Cardiac involvement in amyloid light chain (AL) amyloidosis significantly influences prognosis, necessitating timely diagnosis and meticulous risk stratification.
Objectives: This prospective study aimed to delineate the molecular phenotypes of AL cardiac amyloidosis (AL-CA) by characterizing fibro-amyloid deposition using 18F-florbetapir and gallium-68-labeled fibroblast activation protein inhibitor-04 (68Ga-FAPI-04) positron emission tomography (PET)/computed tomography (CT) imaging. The authors also proposed a novel molecular stratification methodology for prognosis.
Methods: Patients with confirmed AL-CA underwent echocardiography and 18F-florbetapir and 68Ga-FAPI-04 PET/CT imaging. Cardiac amyloid burden was quantified as 18F-florbetapir cardiac amyloid volume and total cardiac amyloid. Meanwhile, cardiac fibroblast activation protein (FAP) was quantified as 68Ga-FAPI-04 cardiac FAP volume (CFV) and total cardiac FAP (TCF). PET/CT metrics were calculated in correlation to clinical and echocardiographic markers and their association with overall survival (OS) evaluated.
Results: Among the 38 patients enrolled (median age: 58 years; 76.3% male), all patients exhibited amyloid deposition, and 86.8% (33 of 38) patients exhibited cardiac fibroblast activation. Cardiac amyloid burden was correlated with Mayo stage and several echocardiography metrics (P < 0.05). In addition, there was a correlation between CFV and N-terminal pro-B-type natriuretic peptide level (P < 0.05). Thirteen deaths occurred over a median follow-up of 24.8 months. Higher CFV and TCF were associated with shortened OS, particularly in Mayo stage III. In multivariable analysis, higher TCF was a primary determinant for shortened OS.
Conclusions: The study underscores that higher TCF on 68Ga-FAPI-04 PET/CT imaging might be a correlated factor of worse clinical outcome in newly diagnosed AL-CA, and this metric seems to be a molecular imaging tool complementary to 18F-florbetapir imaging. The combination might offer a holistic understanding of molecular attributes, assisting in clinical decision-making.
期刊介绍：
JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography.
JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy.
In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.
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