Emerging molecular imaging targets and tools for myocardial fibrosis detection.
Emerging molecular imaging targets and tools for myocardial fibrosis detection.
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DOI：
10.1093/ehjci/jeac242
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发表时间：
2023-02-17
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心肌纤维化是心脏对损伤的常见愈合反应。虽然最初寻求优化患病组织的强度，但纤维化可能变得适应不良，产生僵硬的功能不良和促心律失常的心肌。不同的纤维化模式与不同的心肌疾病状态相关，但纤维化的存在和数量在很大程度上导致不良预后。目前的成像技术可以评估心肌瘢痕形成的程度和模式，但缺乏特异性，并在改变这一过程的窗口可能已经结束时检测到已建立的纤维化的存在。首次，新的分子成像方法，包括镓-68（68 Ga）-成纤维细胞活化蛋白抑制剂正电子发射断层扫描（68 Ga-FAPI PET），可以允许纤维化活动的高度特异性成像。这些方法可以促进早期纤维化检测、活动期与终末期疾病的区分以及疾病进展和治疗反应的评估，从而改善患者护理和临床结果。当各种形式的心肌损伤影响先前健康的心肌时，就会发生心肌纤维化。各种现有的成像技术，包括心血管磁共振，计算机断层扫描，超声心动图和核成像（单光子发射计算机断层扫描和18 F-FDG PET）评估心肌瘢痕的程度和模式。然而，它们对纤维化没有特异性，并且检测可能不再通过治疗改变的已建立的纤维化。新的分子纤维化成像方法可能首次允许纤维化活动的高度特异性成像。相对于现有方式的益处可能包括检测纤维化的最早阶段、区分活动期和终末期疾病、评估对体内治疗的反应以及确定现有和新型药物的抗纤维化潜力。这些新技术仍在研究中，以确定其临床实用性。Trisha Singh医生提供的心肌梗死CMR图像。68 Ga-FAPI-04图片由Zohreh Varasteh博士提供。
Myocardial fibrosis is the heart’s common healing response to injury. While initially seeking to optimize the strength of diseased tissue, fibrosis can become maladaptive, producing stiff poorly functioning and pro-arrhythmic myocardium. Different patterns of fibrosis are associated with different myocardial disease states, but the presence and quantity of fibrosis largely confer adverse prognosis. Current imaging techniques can assess the extent and pattern of myocardial scarring, but lack specificity and detect the presence of established fibrosis when the window to modify this process may have ended. For the first time, novel molecular imaging methods, including gallium-68 (68Ga)-fibroblast activation protein inhibitor positron emission tomography (68Ga-FAPI PET), may permit highly specific imaging of fibrosis activity. These approaches may facilitate earlier fibrosis detection, differentiation of active vs. end-stage disease, and assessment of both disease progression and treatment–response thereby improving patient care and clinical outcomes. Myocardial fibrosis occurs when various forms of myocardial injury affect previously healthy myocardium. Various existing imaging techniques including cardiovascular magnetic resonance, computed tomography, echocardiography, and nuclear imaging (single-photon emission computed tomography and 18F-FDG PET) assess the extent and pattern of myocardium scar. However, they are not specific to fibrosis and detect established fibrosis that may no longer be modifiable with treatment. Novel molecular fibrosis imaging methods may for the first time allow highly specific imaging of fibrosis activity. Benefits over existing modalities may include detection of the earliest stages of fibrogenesis, differentiation between active and end-stage disease, assessment of response to treatment in vivo as well as determination of the anti-fibrotic potential of existing and novel agents. These new techniques remain under investigation to determine their clinical utility. CMR images of myocardial infarction courtesy of Dr Trisha Singh. 68Ga-FAPI-04 Images courtesy of Dr Zohreh Varasteh.
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