What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Atrial fibrillation (n=152). Intervention: 18F-FDG and 18F-FAPI PET imaging vs. Patients without abnormal tracer uptake.

What does this research mean for the field?

18F-FDG and 18F-FAPI PET exhibit spatially divergent uptake patterns in atrial fibrillation, with persistent AF associating with abnormal right atrial 18F-FDG uptake and increased left atrial volume index associating with abnormal left atrial 18F-FAPI uptake. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To characterize and compare the prevalence, intensity, and spatial distribution of atrial tracer uptake using 18F-FDG and 18F-FAPI PET in patients with atrial fibrillation.

October 7, 2026The International Journal of Cardiovascular Imaging

Molecular phenotyping of atrial remodeling in atrial fibrillation using 18F-FDG and 18F-FAPI PET

Q: What are the key findings of this study?

In patients with atrial fibrillation, persistent AF was significantly associated with abnormal right atrial 18F-FDG uptake (p=0.003), while increased left atrial volume index was associated with abnormal left atrial 18F-FAPI uptake (p=0.013).

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Key result

Persistent AF and higher LAVI link to distinct atrial 18F-FDG and 18F-FAPI uptake patterns.

n=152

Why the study?

Atrial remodeling in AF involves metabolic alterations and fibroblast activation, but the spatial patterns of these processes assessed by 18F-FDG and 18F-FAPI PET are not well characterized or compared.

Does 18F-FAPI PET demonstrate a different spatial pattern of atrial remodeling compared to 18F-FDG PET in patients with atrial fibrillation?

Key Points

To characterize and compare the prevalence, intensity, and spatial distribution of atrial tracer uptake using 18F-FDG and 18F-FAPI PET in patients with atrial fibrillation.
Conducted a post hoc cardinality-matched analysis of 90 patients with atrial fibrillation from two prospective PET/CT cohorts (45 imaged with 18F-FDG and 45 with 18F-FAPI).
Measured left atrial volume index (LAVI) using the echocardiographic ellipsoid method.
Assessed differences in tracer uptake intensity, prevalence, and spatial distribution, along with clinical correlates, via univariable analyses and logistic regression.
18F-FAPI demonstrated a significantly higher left atrial target-to-background ratio compared to 18F-FDG (P = 0.007).
Abnormal uptake occurred more frequently with 18F-FDG in the left atrial appendage (83.3% vs. 23.1%, P < 0.001), whereas 18F-FAPI uptake predominated in the anterior wall (84.6% vs. 38.9%, P = 0.002) and roof (69.2% vs. 33.3%, P = 0.019).
Abnormal right atrial 18F-FDG uptake was associated with persistent atrial fibrillation (P = 0.010), while abnormal left atrial 18F-FAPI uptake correlated with higher LAVI (P = 0.021) and lower low-density lipoprotein cholesterol (P = 0.006).

Study Design

Type

Cross-Sectional (n=152)

Multicenter

Structured PICO

Does 18F-FAPI PET demonstrate a different spatial pattern of atrial remodeling compared to 18F-FDG PET in patients with atrial fibrillation?

Population

152 patients with atrial fibrillation who underwent 18F-FDG or 18F-FAPI PET imaging for molecular phenotyping of atrial remodeling.

Exposure

18F-FAPI PET/CT imaging to assess fibroblast activation-related atrial remodeling

Comparator

18F-FDG PET/CT imaging to assess inflammation-related metabolic atrial remodeling

Outcome

Prevalence, intensity (target-to-background ratio), and spatial distribution of abnormal atrial tracer uptake in predefined left and right atrial regionssurrogate

18F-FDG and 18F-FAPI PET demonstrate spatially divergent uptake patterns in the atria of patients with atrial fibrillation, suggesting they provide complementary non-invasive information on inflammatory versus fibrotic atrial remodeling.

Limitations

Small sample sizes in several subgroup analyses
Cross-sectional observational design without longitudinal follow-up
Single-center study
Requires within-patient validation (tracers were assessed in different matched cohorts rather than the same patients)

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Dual-tracer PET may distinguish metabolic from fibrotic atrial remodeling in AF; leaves open clinical adoption without prospective validation.

Cite This Study

Duan et al. (2026) conducted a cross-sectional in Atrial fibrillation (n=152). 18F-FDG and 18F-FAPI PET imaging vs. Patients without abnormal tracer uptake was evaluated. In patients with atrial fibrillation, persistent AF was significantly associated with abnormal right atrial 18F-FDG uptake (p=0.003), while increased left atrial volume index was associated with abnormal left atrial 18F-FAPI uptake (p=0.013).

synapsesocial.com/papers/6ac59ff7164a9ca62de5b32e https://doi.org/10.1007/s10554-026-03838-y

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Implication

Dual-tracer PET may distinguish metabolic from fibrotic atrial remodeling in AF; leaves open clinical adoption without prospective validation.

Molecular phenotyping of atrial remodeling in atrial fibrillation using 18F-FDG and 18F-FAPI PET

Key Points

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Molecular phenotyping of atrial remodeling in atrial fibrillation using 18F-FDG and 18F-FAPI PET

Key Points

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

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