HypertensionMechanistic study
Primary Aldosteronism: CXCR4- and FAP-Targeted Positron Emission Tomography (PET)/MR for Adrenal-Cardiac Axis
- Dual-tracer PET/magnetic resonance imaging study
Authors' conclusion
Dual-tracer PET/magnetic resonance provided in vivo molecular evidence of a CXCR4-FAP-mediated adrenal-cardiac axis in PA, revealing cross-talk between adrenocortical function, aldosterone secretion, and myocardial fibroblast activation beyond blood pressure effects. FAPI PET demonstrated more severe myocardial activation in APA, with partial postadrenalectomy reversibility, underscoring the value of early diagnosis and timely surgical intervention.
Study context
- Population
- Patients with primary aldosteronism (aldosterone-producing adenoma or idiopathic hyperaldosteronism), patients with essential hypertension, and normotensive controlsunderwent 68 Ga-FAPI-04 PET/cardiac magnetic resonance, 48 concurrently underwent 68 Ga-Pentixafor PET/magnetic resonance, 8 patients with aldosterone-producing adenoma (APA) had follow-up imaging postadrenalectomy · primary aldosteronism (PA) 40 · essential hypertension 21 · normotensive controls 21
- Participants
- Eighty-two patients
- Comparison
- Adrenal CXCR4 and myocardial FAPI uptake in PA vs essential hypertension vs normotensive controls
- PAn = 40
- APAn = 21
- idiopathic hyperaldosteronismn = 19
- essential hypertensionn = 21
- normotensive controlsn = 21
Main finding
As reported in the abstract
- Significantly associated with adverse left ventricular remodeling, independent of blood pressure levels or hypertension duration
Further findings
| Outcome | Values |
|---|---|
| Myocardial 68 Ga-FAPI-04 uptake detected | PA 55% · APA 71.4% · idiopathic hyperaldosteronism 36.8% · essential hypertension 19% · normotensive controls 0% |
- Myocardial 68 Ga-FAPI-04 uptake detected: P <0.001
Myocardial 68 Ga-FAPI-04 uptake detected
- Localizing predominantly to the basal septum
Total adrenal volume-adjusted CXCR4 signal vs myocardial FAPI activity
- correlation
- r =0.38-0.64; all P <0.05
- also correlated with cardiac magnetic resonance markers of remodeling; both positively associated with aldosterone levels
Myocardial FAPI uptake post-adrenalectomy in 8 patients with APA · 5.2±1.2 months post-adrenalectomy
- Declined significantly
- P < 0.01
- Late gadolinium enhancement and global cardiac function showed no significant change
Original publication
Summarised from the published abstract; every number is checked against it