目的:本研究旨在评估99mTc放射性标记成纤维细胞活化蛋白抑制剂(99mTc-HFAPi)单光子发射计算机断层扫描(SPECT)成像在急性心肌梗死(AMI)后患者中评估12个月左心室(LV)重塑的预测实用性。
方法:58例AMI患者(46例男性,中位年龄61[53,67]岁)接受基线99mTc-HFAPi成像(MI后5±2天),灌注成像(MI后6±2天),和超声心动图(MI后2±2天)。此外,15例患者随访99mTc-HFAPi和灌注显像,30例患者进行了超声心动图随访。在患者水平评估心肌99mTc-HFAPi活性。LV重塑定义为从基线到随访超声心动图,LV舒张末期直径(LVEDD)或LV收缩末期直径(LVESD)增加≥10%。
结果:AMI患者显示局部但不均匀的99mTc-HFAPi摄取,超过灌注缺陷。基线99mTc-HFAPi活性与BNPmax呈显著相关,LDHmax,cTNImax,和WBCmax,与LVEF呈负相关。12个月后,11例患者(36.66%)经历了左心室重塑。单因素回归分析显示基线99mTc-HFAPi摄取程度与左心室重塑之间存在关联(OR=2.14,95CI,1.04,4.39,p=0.038)。
结论:99mTc-HFAPiSPECT显像有望预测MI后的LV重塑,为患者管理和预后提供有价值的见解。
背景:我们的研究引入了99mTc放射性标记的成纤维细胞活化蛋白抑制剂(99mTc-HFAPi)单光子发射计算机断层扫描(SPECT)成像,作为评估AMI后LV重塑的纤维化过程的潜在成本效益方法。该研究建立了99mTc-HFAPi活性之间的正相关关系,特别是99mTc-HFAPi摄取程度,和左心室重塑,提示99mTc-HFAPiSPECT显像可作为AMI后患者风险预测的有前景的工具。这项研究的发现有可能通过早期识别存在不良LV重塑风险的患者来彻底改变AMI后患者的管理。这种识别可以为量身定制的干预措施铺平道路,可能改善临床结局并减少心力衰竭的发展。
BACKGROUND: Despite improved treatments for acute myocardial infarction (AMI), myocardial fibrosis remains a key driver of adverse left ventricular (LV) remodeling and increased mortality. Fibroblast activation and proliferation significantly contribute to this process by enhancing cardiac fibrosis, which can lead to detrimental changes in LV structure. This study evaluates the effectiveness of 99mTc-labeled fibroblast activation protein inhibitor (99mTc-HFAPi) SPECT imaging in predicting LV remodeling over 12 months in post-AMI patients.
METHODS: A cohort of 58 AMI patients (46 males, median age 61 [53, 67] years) underwent baseline 99mTc-HFAPi imaging (5 ± 2 days post-MI), perfusion imaging (6 ± 2 days post-MI), and echocardiography (2 ± 2 days post-MI). Additionally, 15 patients had follow-up 99mTc-HFAPi and perfusion imaging, while 30 patients had follow-up echocardiography. Myocardial 99mTc-HFAPi activity was assessed at the patient level. LV remodeling was defined as a ≥10% increase in LV end-diastolic diameter (LVEDD) or LV end-systolic diameter (LVESD) from baseline to follow-up echocardiography.
RESULTS: AMI patients displayed localized but non-uniform 99mTc-HFAPi uptake, exceeding perfusion defects. Baseline 99mTc-HFAPi activity exhibited significant correlations with BNPmax, LDHmax, cTNImax, and WBCmax, inversely correlating with LVEF. After 12 months, 11 patients (36.66%) experienced LV remodeling. Univariate regression analysis demonstrated an association between baseline 99mTc-HFAPi uptake extent and LV remodeling (OR = 2.14, 95%CI, 1.04, 4.39, P = 0.038).
CONCLUSIONS: 99mTc-HFAPi SPECT imaging holds promise in predicting LV remodeling post-MI, providing valuable insights for patient management and prognosis.