Myocardial Fibroblast Activation in Ischemic and Nonischemic Cardiomyopathy

What are the patterns of myocardial fibroblast activation in patients with different etiologies of heart failure?In this case-control study, gallium 68–labeled fibroblast activation protein inhibitor 46 ([Ga]FAPI-46) positron emission tomography (PET) and magnetic resonance imaging (MRI) demonstrated increased myocardial fibroblast activation in patients with heart failure; uptake was highest in ischemic cardiomyopathy, localizing to prior infarct, whereas patients with nonischemic cardiomyopathy showed a diffuse, lower-intensity pattern with predominant septal involvement. Fibroblast activation remained stable on repeat imaging, with increased baseline activity associated with less improvement in ejection fraction.[Ga]FAPI-46 PET/MRI demonstrated increased myocardial fibroblast activation in patients with heart failure and may represent an important target for disease-modifying therapy.

Corresponding Author: Shruti S. Joshi, MBBS, PhD, British Heart Foundation Centre of Research Excellence, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom (sjoshi@ed.ac.uk).

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