A FAPI PET-based radiomics model demonstrated an apparent AUC of 0.839 (0.772 after bootstrap correction) for stratifying predicted 5-year sudden cardiac death risk in hypertrophic cardiomyopathy.
Observational (n=92)
Yes
Does a FAPI PET radiomics model improve predicted 5-year sudden cardiac death risk stratification compared to conventional imaging metrics in patients with hypertrophic cardiomyopathy?
FAPI PET-based radiomics is feasible for quantifying myocardial fibroblast activation heterogeneity and shows potential for stratifying sudden cardiac death risk in hypertrophic cardiomyopathy, though performance was comparable to conventional metrics after internal validation.
Effect estimate: AUC 0.772
Background Hypertrophic cardiomyopathy (HCM) is associated with an increased risk of sudden cardiac death (SCD), and myocardial fibrosis plays a central role in the pathophysiology process. Radiolabelled fibroblast activation protein inhibitor (FAPI) positron emission tomography computed tomography (PET) imaging enables visualisation of activated fibroblasts and may detect earlier stages of myocardial fibrosis than conventional structural imaging. However, most previous studies have relied on simple uptake-based metrics, potentially underusing the quantitative information contained in PET images. Objective To develop and internally validate a radiomics model based on FAPI PET imaging for stratifying predicted 5-year SCD risk in patients with HCM. Methods A total of 92 patients with HCM from two centres who underwent FAPI PET/CT or PET/cardiac magnetic resonance (CMR) were retrospectively included. Radiomics features were extracted from myocardial regions of interest and selected using elastic net regression. A radiomics model was constructed and evaluated using bootstrap internal validation. Model performance was compared with a conventional imaging metric (FAPI amount). Sensitivity analysis was performed to assess robustness across imaging modalities. Results Two radiomics features were selected to construct the model. The apparent area under the receiver operating curve of the radiomics model was 0.839, which decreased to 0.772 after bootstrap correction and became comparable to the conventional metric. Sensitivity analysis demonstrated stable model performance after excluding PET/CMR data. Conclusion FAPI PET-based radiomics is feasible for quantifying myocardial fibroblast activation heterogeneity and shows potential for predicted SCD risk stratification in HCM. These findings should be interpreted as proof-of-concept and require validation in larger prospective cohorts with clinical endpoints.
Song et al. (Thu,) conducted a observational in Hypertrophic cardiomyopathy (HCM) (n=92). FAPI PET radiomics model vs. Conventional imaging metric (FAPI amount) was evaluated on Predicted 5-year sudden cardiac death (SCD) risk stratification (AUC 0.772). A FAPI PET-based radiomics model demonstrated an apparent AUC of 0.839 (0.772 after bootstrap correction) for stratifying predicted 5-year sudden cardiac death risk in hypertrophic cardiomyopathy.
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