68 Ga-FAPI right heart uptake in a patient with idiopathic pulmonary arterial hypertension
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Ga-FAPI right heart uptake in a patient with idiopathic pulmonary arterial hypertension Lei Wang, MD, PhD,a Zongyao Zhang, BS,a Zuoquan Zhao, PhD,a Chaowu Yan, MD,b and Wei Fang, MDa a
b
Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China Department of Structural Heart Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
Received Oct 1, 2020; accepted Oct 2, 2020 doi:10.1007/s12350-020-02407-7
INTRODUCTION Fibroblast activation protein inhibitor (FAPI) tracers which initially developed as a ligand for various cancers have been recently used to study cardiac remodeling following myocardial infarction in animal studies. We for the first time present a case of FAPI uptake in the right heart in a patient with pulmonary arterial hypertension. CASE PRESENTATION A 29-year-old female patient was admitted with reduced capacity for exercise, dry cough, and lower limb edema. She was diagnosed with idiopathic pulmonary arterial hypertension (IPAH) confirmed by right-sided heart catheterization with increased mean pulmonary arterial pressure (69 mmHg) and pulmonary vascular resistance (14.48 Wood units). Cardiac magnetic resonance showed a markedly dilated right atrium and enlarged right ventricle (RV) (Figure 1). RV dysfunction was suggested by her decreased 6-minute walking distance (310 m) and elevated level of NT-proBNP (1344.0 pgml) with a tricuspid annular plane systolic excursion at 12 mm.
Reprint requests: Wei Fang, MD, Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright 2020 American Society of Nuclear Cardiology.
A 68Ga-fibroblast activation protein inhibitor (68GaFAPI) PET/CT cardiac imaging was performed as part of a pilot study for PAH (Ethic No.2018-K20-1). Noticeably, significant uptake of 68Ga-FAPI was observed in the myocardium of right heart including RV free wall (SUVmax 2.51) (Figure 2, red arrow) and right atrium (SUVmax 1.95) (Figure 2, yellow arrow). The RV insertion point presented with focal uptake (SUVmax 1.94) (Figure 2, green arrow). Meanwhile, there was no uptake of 68Ga-FAPI in the left ventricular myocardium. Right heart dysfunction is associated with worse prognosis of patients with PAH, while fibrosis is dysregulated in maladaptive cardiac tissue contributing directly to RV failure.1 It has been observed that the presence of late gadolinium enhancement occurs at the RV insertion points of PAH patients possibly due to a finding histologically described as plexiform fibrosis.2 Diffuse RV fibrosis measured by cardiovascular magnetic resonance-derived extracellular volume was also reported in PAH.3 Consequently, it is reasonable to speculate that uptake of FAPI in the right heart suggestive of activated fibroblasts may be related to an early stage of RV remodeling transiting from
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