Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2025
Quantifying right ventricular fibrosis burden in chronic thromboembolic pulmonary hypertension via fibroblast activation protein inhibitor single photon emission computed tomography/computed tomography: Correlation with echocardiographic parameters and balloon pulmonary angiography response.
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Wang Ke, Li Xin, Song Shuyang, Li Hui, Tao Xincao, Fang Wei, Zhao Zhihui, Yan Chaowu, Wang Lei
Аннотация
BACKGROUND: This study aimed to investigate the relationship between pressure overload-induced right ventricular (RV) fibrotic remodeling detected by 99mTc-fibroblast activation protein inhibitor (FAPI) single photon emission computed tomography/computed tomography (SPECT/CT) and echocardiographic biomechanical adaptation/maladaptation in chronic thromboembolic pulmonary hypertension (CTEPH).
METHODS: Thirty-seven CTEPH patients scheduled for balloon pulmonary angiography (BPA) underwent baseline 99mTc-FAPI SPECT/CT, speckle-tracking echocardiography (measuring RV global strain [GS] and free-wall strain [FWS]), and right heart catheterization. Baseline RV FAPI uptake (peak myocardial-to-blood ratio, TBRpeak) was compared with RV strain and RV-pulmonary artery coupling parameters. Twenty patients received repeated BPA sessions, and a subgroup of 10 underwent repeat FAPI SPECT and strain analysis after a single BPA.
RESULTS: Baseline global RV FAPI TBRpeak varied among CTEPH patients (mean ± SD: 2.92 ± 0.96; range: 1.44-4.76). Patients without RV uptake exhibited significantly higher strain values and preserved RV-pulmonary artery coupling compared to those with uptake. TBRpeak of free wall correlated positively with RVGS (r = 0.450, P = 0.005), RVGS/sPAP (global right ventricular longitudinal strain/systolic pulmonary artery pressure) (r = 0.370, P = 0.024), right ventricular free-wall longitudinal strain (RVFWS, r = 0.386, P = 0.018), and RVFWS/sPAP (r = 0.347, P = 0.035). Following a single BPA, RV FAPI uptake decreased in 6 of 10 patients and increased modestly in 4. Changes in FAPI uptake (global ΔTBRpeak) significantly correlated with ΔRVGS (r = 0.697, P = 0.025), ΔRVFWS (r = 0.710, P = 0.022), ΔRVGS/sPAP (r = 0.694, P = 0.026), ΔRVFWS/sPAP (r = 0.700, P = 0.024).
CONCLUSION: In CTEPH, RV fibrotic remodeling quantified by FAPI SPECT/CT correlated with echocardiographic RV strain and ventricular-pulmonary artery coupling. Following BPA, changes in RV FAPI uptake appeared dynamic, with fluctuations potentially corresponding to alterations in both RV strain and ventricular-pulmonary coupling parameters.
METHODS: Thirty-seven CTEPH patients scheduled for balloon pulmonary angiography (BPA) underwent baseline 99mTc-FAPI SPECT/CT, speckle-tracking echocardiography (measuring RV global strain [GS] and free-wall strain [FWS]), and right heart catheterization. Baseline RV FAPI uptake (peak myocardial-to-blood ratio, TBRpeak) was compared with RV strain and RV-pulmonary artery coupling parameters. Twenty patients received repeated BPA sessions, and a subgroup of 10 underwent repeat FAPI SPECT and strain analysis after a single BPA.
RESULTS: Baseline global RV FAPI TBRpeak varied among CTEPH patients (mean ± SD: 2.92 ± 0.96; range: 1.44-4.76). Patients without RV uptake exhibited significantly higher strain values and preserved RV-pulmonary artery coupling compared to those with uptake. TBRpeak of free wall correlated positively with RVGS (r = 0.450, P = 0.005), RVGS/sPAP (global right ventricular longitudinal strain/systolic pulmonary artery pressure) (r = 0.370, P = 0.024), right ventricular free-wall longitudinal strain (RVFWS, r = 0.386, P = 0.018), and RVFWS/sPAP (r = 0.347, P = 0.035). Following a single BPA, RV FAPI uptake decreased in 6 of 10 patients and increased modestly in 4. Changes in FAPI uptake (global ΔTBRpeak) significantly correlated with ΔRVGS (r = 0.697, P = 0.025), ΔRVFWS (r = 0.710, P = 0.022), ΔRVGS/sPAP (r = 0.694, P = 0.026), ΔRVFWS/sPAP (r = 0.700, P = 0.024).
CONCLUSION: In CTEPH, RV fibrotic remodeling quantified by FAPI SPECT/CT correlated with echocardiographic RV strain and ventricular-pulmonary artery coupling. Following BPA, changes in RV FAPI uptake appeared dynamic, with fluctuations potentially corresponding to alterations in both RV strain and ventricular-pulmonary coupling parameters.