Background: FAP (fibroblast activation protein) plays an important role in cardiac wound healing and remodeling. Although initially developed as a theranostic ligand for metastasized cancer, FAPI (FAP inhibitor) tracers have recently been used to study cardiac remodeling following myocardial infarction in small-animal models. The aim of the study was to evaluate the activity of FAP via FAPI–positron emission tomography–computed tomography scans in human hearts. Methods: FAPI–positron emission tomography–computed tomography scans of 229 patients of 2 consecutive cohorts (modeling cohort: n=185; confirmatory cohort: n=44) suffering from metastasized cancer were analyzed applying the American Heart Association 17-segment model of the left ventricle. Logistic regression models were created using data from the modeling cohort. Multivariate regression models were established using Akaike information criterion in a step-down approach. Results: Fourteen percent of patients had preexisting coronary artery disease (n=31), 33% arterial hypertension (n=75), and 12% diabetes mellitus type II (n=28). Forty-three percent had been treated with platin derivatives (n=100), 14% with anthracyclines (n=32), and 10% had a history of prior radiation to the chest (n=23). High left ventricular FAPI signals correlated with the presence of cardiovascular risk factors (odds ratio [OR], 4.3, P =0.0029), a focal myocardial signal pattern (OR, 3.9, P =0.0068), diabetes mellitus type II (OR, 4.1, P =0.046), and beta-blocker use (OR, 3.8, P =0.049) in univariate regression models. In a multivariate analysis, increased signal intensity was significantly higher in patients with cardiovascular risk factors (overweight [OR, 2.6, P =0.023], diabetes mellitus type II [OR, 2.9, P =0.041], certain chemotherapies [platinum derivatives; OR, 3.0, P =0.034], and a history of radiation to the chest [OR, 3.5, P =0.024]). A focal enrichment pattern was more frequently observed in patients with known cardiovascular risk factors ( P <0.0001). Conclusions: FAPI–positron emission tomography–computed tomography scans represent a new imaging modality to investigate cardiac FAP. High signal intensities correlate with cardiovascular risk factors and metabolic disease.

Intra-arterial (i.a.) and transcutaneous (t.c.) blood gas monitoring were compared with in vitro blood gas analysis (abg) during apnoea testing for the determination of brain death in a prospective observational study. All three methods were used simultaneously in 19 patients in whom brain death was suspected. Brain death was confirmed in each case adhering to the recommendations of the Scientific Advisory Board of the German Federal Chamber of Physicians which demand a PCO2 of at least 60 mmHg. In vitro parameters ranged from 23.2 to 80.4 mmHg (PCO2), 52.7 to 509.9 mmHg (PO2), and 7.072 to 7.591 (pH). The intra-individual correlations between both monitoring methods (rPCO2=0.958, rPO2=0.859) and between each of them and abg (r>0.960) were high. Absolute deviations from abg for the corrected as well as uncorrected measurements were similar for both methods, except with regard to group bias where an advantage for the i.a. values emerged. Since many of the i.a. measurements failed and the disposable i.a. probes cost much more than the t.c. electrodes, the i.a. technique at present holds no advantage over t.c. measurements in testing for apnoea in suspected brain death except where simultaneous monitoring of pH and temperature are desired.

Zusammenfassung Es sollte gepr?ft werden, ob ein routinem??iges Miterfassen von Herzfunktions- (BNP) und Herznekrose (Troponin-I)-Parametern in der Fr?hphase des Schlaganfalls verwertbare Hinweise auf ein Mitreagieren des Herzens mit Relevanz hinsichtlich einer kardiologischen Mitbehandlung gibt. Vom 1.10.2009 bis 30.9.2010 wurden alle 168 im Zeitfenster von 24 Stunden auf der Stroke Unit im Lausitzer Seenland Klinikum eintreffenden Patienten mit isch?mischem Schlaganfall nach vorher streng standardisierten (OPS 8-981) und EDV-technisch ?berwachten Rahmenbedingungen (eigens entwickeltes ?Informationssystem Stroke Unit?) behandelt und gleichzeitig einer kardiologischen Diagnostik unterzogen. Die BNP- und Troponin-I-Werte wurden bei Eintreffen, 8 Stunden danach und zu sp?teren Zeitpunkten standardisiert erhoben. Kardiale Funktionsst?rungen/Vorerkrankungen waren bei zwei Drittel (65,5?%) der Schlaganfallpatienten gegeben. Die BNP-Werte von Schlaganfallpatienten auf der Grundlage einer kardiogenen Embolie waren signifikant erh?ht. Eine signifikante BNP-Erh?hung zeigten auch Schlaganfallpatienten mit Einbezogensein des rechten Inselkortexes. Die Troponinserumspiegel der Schlaganfallpatienten waren zu einem Viertel zumindest leicht erh?ht, bei 4???7?% fand sich eine Erh?hung wie sie sonst nur beim akuten Myokardinfarkt angetroffen wird. Bei kardiogenen Embolien waren die Troponinwerte gegen?ber denen mit Mikroangiopathie signifikant h?her. Auch die Beteiligung des rechten Inselkortexes lie? signifikant erh?hte Troponin-I-Werte erkennen. Es ergibt sich die Schlussfolgerung, dass in der Fr?hphase des Schlaganfalls bei Patienten mit kardialer Embolie und/oder Beteiligtsein von zentralen Steuerungszentren der vegetativen Autonomie (hier demonstriert am rechten Inselkortex) erh?hter Bedarf an kardiologischer Mitbetreuung vorliegt und dass die Bestimmung der Serumspiegel von BNP und Troponin I dies erh?rten kann.