Delayed 68Ga-FAPI-46 PET/MR imaging confirms ongoing fibroblast activation in patients after acute myocardial infarction

Jana Kupusovic; Lukas Kessler; Sandra Kazek; Michal Kamil Chodyla; Lale Umutlu; Fadi Zarrad; Michael Nader; Wolfgang P Fendler; Zohreh Varasteh; Ken Hermann; Dobromir Dobrev; Reza Wakili; Tienush Rassaf; Johannes Siebermair; Christoph Rischpler

doi:10.1016/j.ijcha.2024.101340

Delayed ⁶⁸Ga-FAPI-46 PET/MR imaging confirms ongoing fibroblast activation in patients after acute myocardial infarction

Int J Cardiol Heart Vasc. 2024 Jan 23:50:101340. doi: 10.1016/j.ijcha.2024.101340. eCollection 2024 Feb.

Authors

Jana Kupusovic^{1

2}, Lukas Kessler³, Sandra Kazek³, Michal Kamil Chodyla⁴, Lale Umutlu⁴, Fadi Zarrad³, Michael Nader³, Wolfgang P Fendler³, Zohreh Varasteh^{3

5}, Ken Hermann³, Dobromir Dobrev^{6

7

8}, Reza Wakili^{1

2

9}, Tienush Rassaf¹, Johannes Siebermair^{1

10}, Christoph Rischpler^{3

11}

Affiliations

¹ Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany.
² Department of Medicine and Cardiology, Goethe University, Frankfurt, Germany.
³ Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
⁴ Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
⁵ Department of Nuclear Medicine, Klinikum Rechts der Isar der TUM, Technical University of Munich, Munich, Germany.
⁶ Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.
⁷ Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, TX, United States.
⁸ Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada.
⁹ German Center for Cardiovascular Research DZHK, Partner site Rhine-Main, Germany.
¹⁰ Department of Cardiology, Krankenhaus Göttlicher Heiland GmbH, Vienna, Austria.
¹¹ Department of Nuclear Medicine, Klinikum Stuttgart, Stuttgart, Germany.

Abstract

Purpose of the report: Combined cardiac ⁶⁸Ga-Fibroblast-Activation Protein-alpha inhibitor (FAPI) positron-emission tomography (PET) and cardiac magnetic resonance imaging (MRI) constitute a novel diagnostic tool in patients for the assessment of myocardial damage after an acute myocardial infarction (AMI). Purpose of this pilot study was to evaluate simultaneous Ga-68-FAPI-46-PET/MR imaging in the delayed phase after AMI.

Material and methods: Eleven patients underwent hybrid ⁶⁸Ga-FAPI-46 PET/MRI post AMI. Standardized uptake values and fibroblast activation volume (FAV) were calculated and correlated with serum biomarkers and MRI parameters.

Results: Significant ⁶⁸Ga-FAPI-46 uptake could be demonstrated in 11 (100 %) patients after a mean period of 30.9 ± 22.0 days. FAV significantly exceeded the infarction size in MRI and showed a good correlation to MRI parameters as well as to serum biomarkers of myocardial damage.

Conclusions: ⁶⁸Ga-FAPI-46 PET/MRI offers molecular and morphological imaging of affected myocardium after AMI. This study demonstrates ongoing fibroblast activation in a delayed phase after AMI and generates hypotheses for future studies while aiming for a better understanding of myocardial remodeling following ischemic tissue damage.

Keywords: Acute coronary syndrome; Cardiovascular imaging; FAPI; Fibroblast activation; Myocardial infarction; PET/MRI.