Noninvasive Assessment of Renal Fibrosis of Chronic Kidney Disease in Rats by [68Ga]Ga-FAPI-04 Small Animal PET/CT and Biomarkers.

Renal fibrosis is the most common pathological feature and common pathway of progression in chronic kidney disease (CKD). We evaluated [68Ga]Ga-FAPI-04 small animal positron emission tomography/computed tomography (PET/CT) and biomarkers as noninvasive assessments of renal fibrosis (RF) in CKD rats to generate new ideas for clinical diagnosis. A rat model of renal fibrosis was administered adenine by gavage (n = 28), and the control group was given 0.9% NaCl by gavage (n = 20). At different time points (weeks 1, 2, 4, and 6), five rats were randomly selected from the two groups for [68Ga]Ga-FAPI-04 small animal PET/CT imaging. At the same time, the expression of Fibroblast activation protein (FAP) in renal tissue and the expression levels of type III procollagen N-terminal peptide (PIIINP), transforming growth factor (TGF-ß1), Klotho, and sex-determining region Y-box protein 9 (SOX9) in blood and urine were determined. FAP was highly expressed in the renal tissue of rats in the CKD group and expression increased with the progression of renal fibrosis. [68Ga]Ga-FAPI-04 small animal PET/CT examination showed that the uptake of radioactive tracers in the CKD group was higher than that in the control group, and SUVmax (r = 0.9405) and target-to-background ratio (TBR) (r = 0.9392) were positively correlated with renal fibrosis. The serum levels of PIIINP, TGF-ß1, and SOX9 in CKD rats were significantly higher than those in the control group and were positively correlated with RF (r = 0.8234, r = 0.7733, and r = 0.7135, respectively) and SUVmax (r = 0.8412, r = 0.7763, and r = 0.6814, respectively). Compared with the control group, the level of serum Klotho decreased and was negatively correlated with RF (r = -0.6925) and SUVmax (r = -0.6322). Compared with the control group, the levels of PIIINP and TGF-ß1 in urine were positively correlated with RF (r = 0.8127 and r = 0.8077, respectively) and SUVmax (r = 0.8400 and r = 0.8177, respectively). Urine Klotho decreased compared with the control group and was negatively correlated with RF (r = -0.5919) and SUVmax (r = -0.5995). The change in urine SOX9 was not statistically significant. In conclusion, compared with renal biopsy, [68Ga]Ga-FAPI-04 small animal PET/CT shows renal fibrosis quickly and noninvasively. PIIINP, TGF-ß1, and Klotho in serum and urine may be used as biomarkers of RF, and serum SOX9 is expected to become a new diagnostic biomarker of RF.

Triangular resection versus neochordal replacement for posterior leaflet prolapse: a morphological assessment.

OBJECTIVES: To evaluate the morphological reconstruction as assessed by 3D transoesophageal echocardiography after triangular resection and neochordal replacement in the treatment of posterior leaflet prolapse. METHODS: We retrospectively selected 46 patients with isolated posterior leaflet prolapse who were undergoing mitral valve repair using triangular resection (n = 20) and neochordal replacement (n = 26) techniques. Sixty patients without valvular heart disease were also included as the control group. Thorough 3D transoesophageal echocardiography inspections were performed for the entire cohort, and morphological parameters of mitral valve complex were measured and compared. Mid-term repair durability was followed up by transthoracic echocardiography. RESULTS: The baseline parameters, including annular size, leaflet tenting, leaflet area, coaptation line lengths and aortomitral angle, were significantly larger in prolapsed valves. After repair, tenting volume, exposed posterior leaflet area and coaptation line lengths were restored to the normal range. Baseline clinical characteristics and 3D transoesophageal echocardiography parameters were comparable in patients treated with 2 techniques, and all parameters remained comparable between the resection and the non-resection groups after repair, except for exposed posterior leaflet area and posterior leaflet ratio. At 62.2 ± 18.5 months after surgery, degrees of residual regurgitation were similar between 2 techniques. CONCLUSIONS: Triangular resection and neochordal replacement can achieve comparable restoration to structural normality and functional competency of mitral valves with posterior leaflet prolapse. Resection of prolapsed segment does not significantly affect coaptation geometry but instead may aid in achieving normal posterior leaflet ratio.