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Sheppard AJ, Theng EH, Paravastu SS, Wojnowski NM, Farhadi F, Morris MA, Hartley IR, Rachel IG, Roszko KL, Collins MT, Saboury B. Spatial Atlas for Mapping Vascular Microcalcification Using 18F-NaF PET/CT: Application in Hyperphosphatemic Familial Tumoral Calcinosis. Arterioscler Thromb Vasc Biol 2024; 44:1432-1446. [PMID: 38660800 PMCID: PMC11111330 DOI: 10.1161/atvbaha.123.320455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Vascular calcification causes significant morbidity and occurs frequently in diseases of calcium/phosphate imbalance. Radiolabeled sodium fluoride positron emission tomography/computed tomography has emerged as a sensitive and specific method for detecting and quantifying active microcalcifications. We developed a novel technique to quantify and map total vasculature microcalcification to a common space, allowing simultaneous assessment of global disease burden and precise tracking of site-specific microcalcifications across time and individuals. METHODS To develop this technique, 4 patients with hyperphosphatemic familial tumoral calcinosis, a monogenic disorder of FGF23 (fibroblast growth factor-23) deficiency with a high prevalence of vascular calcification, underwent radiolabeled sodium fluoride positron emission tomography/computed tomography imaging. One patient received serial imaging 1 year after treatment with an IL-1 (interleukin-1) antagonist. A radiolabeled sodium fluoride-based microcalcification score, as well as calcification volume, was computed at all perpendicular slices, which were then mapped onto a standardized vascular atlas. Segment-wise mCSmean and mCSmax were computed to compare microcalcification score levels at predefined vascular segments within subjects. RESULTS Patients with hyperphosphatemic familial tumoral calcinosis had notable peaks in microcalcification score near the aortic bifurcation and distal femoral arteries, compared with a control subject who had uniform distribution of vascular radiolabeled sodium fluoride uptake. This technique also identified microcalcification in a 17-year-old patient, who had no computed tomography-defined calcification. This technique could not only detect a decrease in microcalcification score throughout the patient treated with an IL-1 antagonist but it also identified anatomic areas that had increased responsiveness while there was no change in computed tomography-defined macrocalcification after treatment. CONCLUSIONS This technique affords the ability to visualize spatial patterns of the active microcalcification process in the peripheral vasculature. Further, this technique affords the ability to track microcalcifications at precise locations not only across time but also across subjects. This technique is readily adaptable to other diseases of vascular calcification and may represent a significant advance in the field of vascular biology.
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Affiliation(s)
- Aaron J Sheppard
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
- Louisiana State University Health Shreveport, School of Medicine, Shreveport, LA, 71103
| | - Elizabeth H Theng
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
- Department of Radiology, Stanford School of Medicine, Stanford, CA, 94304
| | - Sriram S Paravastu
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
- University of Missouri – Kansas City School of Medicine, Kansas City, MO, 64108
| | - Natalia M Wojnowski
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611
| | - Faraz Farhadi
- Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, MD, 20892
- Geisel School of Medicine, Dartmouth, Hanover, NH, 03755
- Institute of Nuclear Medicine, Bethesda, MD, USA
| | | | - Iris R Hartley
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
| | - I Gafni Rachel
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
| | - Kelly L Roszko
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
| | - Michael T Collins
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
| | - Babak Saboury
- Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, MD, 20892
- Institute of Nuclear Medicine, Bethesda, MD, USA
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Kwiecinski J. Role of 18F-sodium fluoride positron emission tomography in imaging atherosclerosis. J Nucl Cardiol 2024; 35:101845. [PMID: 38479575 DOI: 10.1016/j.nuclcard.2024.101845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 04/08/2024]
Abstract
Atherosclerosis involving vascular beds across the human body remains the leading cause of death worldwide. Coronary and peripheral artery disease, which are almost universally a result of atherosclerotic plaque, can manifest clinically as myocardial infarctions, ischemic stroke, or acute lower-limb ischemia. Beyond imaging myocardial perfusion and blood-flow, nuclear imaging has the potential to depict the activity of the processes that are directly implicated in the atherosclerotic plaque progression and rupture. Out of several tested tracers to date, the literature is most advanced for 18F-sodium fluoride positron emission tomography. In this review, we present the latest data in the field of atherosclerotic 18F-sodium fluoride positron emission tomography imaging, discuss the advantages and limitation of the techniques, and highlight the aspects that require further research in the future.
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Affiliation(s)
- Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
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Maier A, Teunissen AJP, Nauta SA, Lutgens E, Fayad ZA, van Leent MMT. Uncovering atherosclerotic cardiovascular disease by PET imaging. Nat Rev Cardiol 2024:10.1038/s41569-024-01009-x. [PMID: 38575752 DOI: 10.1038/s41569-024-01009-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
Assessing atherosclerosis severity is essential for precise patient stratification. Specifically, there is a need to identify patients with residual inflammation because these patients remain at high risk of cardiovascular events despite optimal management of cardiovascular risk factors. Molecular imaging techniques, such as PET, can have an essential role in this context. PET imaging can indicate tissue-based disease status, detect early molecular changes and provide whole-body information. Advances in molecular biology and bioinformatics continue to help to decipher the complex pathogenesis of atherosclerosis and inform the development of imaging tracers. Concomitant advances in tracer synthesis methods and PET imaging technology provide future possibilities for atherosclerosis imaging. In this Review, we summarize the latest developments in PET imaging techniques and technologies for assessment of atherosclerotic cardiovascular disease and discuss the relationship between imaging readouts and transcriptomics-based plaque phenotyping.
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Affiliation(s)
- Alexander Maier
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Abraham J P Teunissen
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn Genomics Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sheqouia A Nauta
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Esther Lutgens
- Cardiovascular Medicine and Immunology, Experimental Cardiovascular Immunology Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mandy M T van Leent
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Nicholls SJ. Serial PET imaging to evaluate medical therapies: Is it ready for prime time? Atherosclerosis 2024:117517. [PMID: 38582638 DOI: 10.1016/j.atherosclerosis.2024.117517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Stephen J Nicholls
- Victorian Heart Institute, Monash University, Melbourne, 631 Blackburn Road, Clayton, VIC, 3168, Australia.
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Caddy HT, Kelsey LJ, Parker LP, Green DJ, Doyle BJ. Modelling large scale artery haemodynamics from the heart to the eye in response to simulated microgravity. NPJ Microgravity 2024; 10:7. [PMID: 38218868 PMCID: PMC10787773 DOI: 10.1038/s41526-024-00348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
We investigated variations in haemodynamics in response to simulated microgravity across a semi-subject-specific three-dimensional (3D) continuous arterial network connecting the heart to the eye using computational fluid dynamics (CFD) simulations. Using this model we simulated pulsatile blood flow in an upright Earth gravity case and a simulated microgravity case. Under simulated microgravity, regional time-averaged wall shear stress (TAWSS) increased and oscillatory shear index (OSI) decreased in upper body arteries, whilst the opposite was observed in the lower body. Between cases, uniform changes in TAWSS and OSI were found in the retina across diameters. This work demonstrates that 3D CFD simulations can be performed across continuously connected networks of small and large arteries. Simulated results exhibited similarities to low dimensional spaceflight simulations and measured data-specifically that blood flow and shear stress decrease towards the lower limbs and increase towards the cerebrovasculature and eyes in response to simulated microgravity, relative to an upright position in Earth gravity.
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Affiliation(s)
- Harrison T Caddy
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Australia and the UWA Centre for Medical Research, The University of Western Australia, Perth, WA, Australia
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, WA, Australia
| | - Lachlan J Kelsey
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Australia and the UWA Centre for Medical Research, The University of Western Australia, Perth, WA, Australia
- School of Engineering, The University of Western Australia, Perth, WA, Australia
| | - Louis P Parker
- FLOW, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, WA, Australia
| | - Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Australia and the UWA Centre for Medical Research, The University of Western Australia, Perth, WA, Australia.
- School of Engineering, The University of Western Australia, Perth, WA, Australia.
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Kitagawa T, Sasaki K, Fujii Y, Ikegami Y, Tatsugami F, Awai K, Hirokawa Y, Nakano Y. 18F-sodium fluoride positron emission tomography following coronary computed tomography angiography in predicting long-term coronary events: a 5-year follow-up study. J Nucl Cardiol 2023; 30:2365-2378. [PMID: 37127726 DOI: 10.1007/s12350-023-03277-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE The predictive value of 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) in combination with coronary computed tomography (CT) angiography (CCTA) for future coronary events has attracted interest. We evaluated the potential of 18F-NaF PET/CT following CCTA to predict major coronary events (MACE) during a 5-year follow-up period. METHODS Forty patients with coronary atherosclerotic lesions detected on CCTA underwent 18F-NaF PET/CT examination. Each lesion was evaluated for luminal stenosis and high-risk plaque (HRP) with < 30 Hounsfield units and a > 1.1 remodeling index on CCTA. Focal 18F-NaF uptake in each lesion was quantified using the maximum tissue-to-background ratio (TBRmax), and the maximum TBRmax per patient (M-TBRmax) was determined. We followed MACE (cardiac death, acute coronary syndrome, and/or coronary revascularization > 6 months after 18F-NaF PET/CT) for 5 years. RESULTS In total, 142 coronary lesions were analyzed. Eleven patients experienced any MACE. Patients with MACE showed a higher M-TBRmax than those without (1.40 ± .19 vs. 1.18 ± .18, P = .0011), and the optimal M-TBRmax cutoff to predict MACE was 1.29. Patients with M-TBRmax of ≥ 1.29 had a higher risk of MACE than those with lower values (P = .012, log-rank test), whereas patients with obstructive stenosis and those with HRP did not. Multivariate Cox proportional analysis adjusted for age, sex, coronary risk factors, and CCTA findings showed that M-TBRmax of ≥ 1.29 remained an independent predictor of 5-year MACE (hazard ratio, 5.4; 95% confidence interval, 1.1-25.4; P = .034). CONCLUSION 18F-NaF PET/CT following CCTA provides useful strategies to predict 5-year MACE.
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Affiliation(s)
- Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Ko Sasaki
- Hiroshima Heiwa Clinic, Hiroshima, Japan
| | - Yuto Fujii
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yuki Ikegami
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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Ahmed M, Hakim D, Stone PH. The plaque hypothesis: understanding mechanisms of plaque progression and destabilization, and implications for clinical management. Curr Opin Cardiol 2023; 38:496-503. [PMID: 37767898 PMCID: PMC10958790 DOI: 10.1097/hco.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
PURPOSE OF REVIEW Major adverse cardiac events (MACE) typically arise from nonflow-limiting coronary artery disease and not from flow-limiting obstructions that cause ischemia. This review elaborates the current understanding of the mechanism(s) for plaque development, progression, and destabilization and how identification of these high-risk features can optimally inform clinical management. RECENT FINDINGS Advanced invasive and noninvasive coronary imaging and computational postprocessing enhance an understanding of pathobiologic/pathophysiologic features of coronary artery plaques prone to destabilization and MACE. Early investigations of high-risk plaques focused on anatomic and biochemical characteristics (large plaque burden, severe luminal obstruction, thin cap fibroatheroma morphology, and large lipid pool), but more recent studies underscore that additional factors, particularly biomechanical factors [low endothelial shear stress (ESS), high ESS gradient, plaque structural stress, and axial plaque stress], provide the critical incremental stimulus acting on the anatomic substrate to provoke plaque destabilization. These destabilizing features are often located in areas distant from the flow-limiting obstruction or may exist in plaques without any flow limitation. Identification of these high-risk, synergistic plaque features enable identification of plaques prone to destabilize regardless of the presence or absence of a severe obstruction (Plaque Hypothesis). SUMMARY Local plaque topography, hemodynamic patterns, and internal plaque constituents constitute high-risk features that may be located along the entire course of the coronary plaque, including both flow-limiting and nonflow-limiting regions. For coronary interventions to have optimal clinical impact, it will be critical to direct their application to the plaque area(s) at highest risk.
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Affiliation(s)
- Mona Ahmed
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden
| | - Diaa Hakim
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter H. Stone
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Blanchard I, Vootukuru N, Bhattaru A, Patil S, Rojulpote C. PET Radiotracers in Atherosclerosis: A Review. Curr Probl Cardiol 2023; 48:101925. [PMID: 37392979 DOI: 10.1016/j.cpcardiol.2023.101925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
Traditional atherosclerosis imaging modalities are limited to late stages of disease, prior to which patients are frequently asymptomatic. Positron emission tomography (PET) imaging allows for the visualization of metabolic processes underscoring disease progression via radioactive tracer, allowing earlier-stage disease to be identified. 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG) uptake largely reflects the metabolic activity of macrophages, but is unspecific and limited in its utility. By detecting areas of microcalcification, 18F-Sodium Fluoride (18F-NaF) uptake also provides insight into atherosclerosis pathogenesis. Gallium-68 DOTA-0-Tyr3-Octreotate (68Ga-DOTATATE) PET has also shown potential in identifying vulnerable atherosclerotic plaques with high somatostatin receptor expression. Finally, 11-carbon (11C)-choline and 18F-fluoromethylcholine (FMCH) tracers may identify high-risk atherosclerotic plaques by detecting increased choline metabolism. Together, these radiotracers quantify disease burden, assess treatment efficacy, and stratify risk for adverse cardiac events.
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Affiliation(s)
| | - Nishita Vootukuru
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Abhijit Bhattaru
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ; Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | - Chaitanya Rojulpote
- Department of Radiology, University of Pennsylvania, Philadelphia, PA; Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, PA.
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Moss A, Daghem M, Tzolos E, Meah MN, Wang KL, Bularga A, Adamson PD, Kwiecinski J, Fletcher A, Dawson D, Arumugam P, Sabharwal N, Greenwood JP, Townend JN, Calvert PA, Rudd JHF, Berman D, Verjans J, Slomka P, Dey D, Forsyth L, Murdoch L, Lee RJ, Lewis S, Mills NL, van Beek EJR, Williams MC, Dweck MR, Newby DE. Coronary Atherosclerotic Plaque Activity and Future Coronary Events. JAMA Cardiol 2023; 8:755-764. [PMID: 37379010 PMCID: PMC10308296 DOI: 10.1001/jamacardio.2023.1729] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
Importance Recurrent coronary events in patients with recent myocardial infarction remain a major clinical problem. Noninvasive measures of coronary atherosclerotic disease activity have the potential to identify individuals at greatest risk. Objective To assess whether coronary atherosclerotic plaque activity as assessed by noninvasive imaging is associated with recurrent coronary events in patients with myocardial infarction. Design, Setting, and Participants This prospective, longitudinal, international multicenter cohort study recruited participants aged 50 years or older with multivessel coronary artery disease and recent (within 21 days) myocardial infarction between September 2015 and February 2020, with a minimum 2 years' follow-up. Intervention Coronary 18F-sodium fluoride positron emission tomography and coronary computed tomography angiography. Main Outcomes and Measures Total coronary atherosclerotic plaque activity was assessed by 18F-sodium fluoride uptake. The primary end point was cardiac death or nonfatal myocardial infarction but was expanded during study conduct to include unscheduled coronary revascularization due to lower than anticipated primary event rates. Results Among 2684 patients screened, 995 were eligible, 712 attended for imaging, and 704 completed an interpretable scan and comprised the study population. The mean (SD) age of participants was 63.8 (8.2) years, and most were male (601 [85%]). Total coronary atherosclerotic plaque activity was identified in 421 participants (60%). After a median follow-up of 4 years (IQR, 3-5 years), 141 participants (20%) experienced the primary end point: 9 had cardiac death, 49 had nonfatal myocardial infarction, and 83 had unscheduled coronary revascularizations. Increased coronary plaque activity was not associated with the primary end point (hazard ratio [HR], 1.25; 95% CI, 0.89-1.76; P = .20) or unscheduled revascularization (HR, 0.98; 95% CI, 0.64-1.49; P = .91) but was associated with the secondary end point of cardiac death or nonfatal myocardial infarction (47 of 421 patients with high plaque activity [11.2%] vs 19 of 283 with low plaque activity [6.7%]; HR, 1.82; 95% CI, 1.07-3.10; P = .03) and all-cause mortality (30 of 421 patients with high plaque activity [7.1%] vs 9 of 283 with low plaque activity [3.2%]; HR, 2.43; 95% CI, 1.15-5.12; P = .02). After adjustment for differences in baseline clinical characteristics, coronary angiography findings, and Global Registry of Acute Coronary Events score, high coronary plaque activity was associated with cardiac death or nonfatal myocardial infarction (HR, 1.76; 95% CI, 1.00-3.10; P = .05) but not with all-cause mortality (HR, 2.01; 95% CI, 0.90-4.49; P = .09). Conclusions and Relevance In this cohort study of patients with recent myocardial infarction, coronary atherosclerotic plaque activity was not associated with the primary composite end point. The findings suggest that risk of cardiovascular death or myocardial infarction in patients with elevated plaque activity warrants further research to explore its incremental prognostic implications.
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Affiliation(s)
- Alastair Moss
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
- National Institute for Health and Care Research, Leicester Biomedical Research Centre, University of Leicester, Leicester, England
| | - Marwa Daghem
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Evangelos Tzolos
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Mohammed N. Meah
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Kang-Ling Wang
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Anda Bularga
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Philip D. Adamson
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Alison Fletcher
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, Aberdeen, Scotland
| | | | - Nikant Sabharwal
- Oxford University Hospitals, NHS Foundation Trust, Oxford, England
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, England
| | - Jon N. Townend
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, England
| | | | - James H. F. Rudd
- Department of Medicine, University of Cambridge, Cambridge, England
| | - Dan Berman
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Johan Verjans
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Piotr Slomka
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Laura Forsyth
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Lauren Murdoch
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Robert J. Lee
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Steff Lewis
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Nicholas L. Mills
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
- Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Edwin J. R. van Beek
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Michelle C. Williams
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - Marc R. Dweck
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
| | - David E. Newby
- Edinburgh Imaging, The University of Edinburgh, Edinburgh, Scotland
- British Heart Foundation Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, Scotland
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NaF-PET Imaging of Atherosclerosis Burden. J Imaging 2023; 9:jimaging9020031. [PMID: 36826950 PMCID: PMC9966512 DOI: 10.3390/jimaging9020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The method of 18F-sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) of atherosclerosis was introduced 12 years ago. This approach is particularly interesting because it demonstrates microcalcification as an incipient sign of atherosclerosis before the development of arterial wall macrocalcification detectable by CT. However, this method has not yet found its place in the clinical routine. The more exact association between NaF uptake and future arterial calcification is not fully understood, and it remains unclear to what extent NaF-PET may replace or significantly improve clinical cardiovascular risk scoring. The first 10 years of publications in the field were characterized by heterogeneity at multiple levels, and it is not clear how the method may contribute to triage and management of patients with atherosclerosis, including monitoring effects of anti-atherosclerosis intervention. The present review summarizes findings from the recent 2¾ years including the ability of NaF-PET imaging to assess disease progress and evaluate response to treatment. Despite valuable new information, pertinent questions remain unanswered, not least due to a pronounced lack of standardization within the field and of well-designed long-term studies illuminating the natural history of atherosclerosis and effects of intervention.
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Parry R, Majeed K, Pixley F, Hillis GS, Francis RJ, Schultz CJ. Unravelling the role of macrophages in cardiovascular inflammation through imaging: a state-of-the-art review. Eur Heart J Cardiovasc Imaging 2022; 23:e504-e525. [PMID: 35993316 DOI: 10.1093/ehjci/jeac167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular disease remains the leading cause of death and disability for patients across the world. Our understanding of atherosclerosis as a primary cholesterol issue has diversified, with a significant dysregulated inflammatory component that largely remains untreated and continues to drive persistent cardiovascular risk. Macrophages are central to atherosclerotic inflammation, and they exist along a functional spectrum between pro-inflammatory and anti-inflammatory extremes. Recent clinical trials have demonstrated a reduction in major cardiovascular events with some, but not all, anti-inflammatory therapies. The recent addition of colchicine to societal guidelines for the prevention of recurrent cardiovascular events in high-risk patients with chronic coronary syndromes highlights the real-world utility of this class of therapies. A highly targeted approach to modification of interleukin-1-dependent pathways shows promise with several novel agents in development, although excessive immunosuppression and resulting serious infection have proven a barrier to implementation into clinical practice. Current risk stratification tools to identify high-risk patients for secondary prevention are either inadequately robust or prohibitively expensive and invasive. A non-invasive and relatively inexpensive method to identify patients who will benefit most from novel anti-inflammatory therapies is required, a role likely to be fulfilled by functional imaging methods. This review article outlines our current understanding of the inflammatory biology of atherosclerosis, upcoming therapies and recent landmark clinical trials, imaging modalities (both invasive and non-invasive) and the current landscape surrounding functional imaging including through targeted nuclear and nanobody tracer development and their application.
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Affiliation(s)
- Reece Parry
- School of Medicine, University of Western Australia, Perth 6009, Australia.,Department of Cardiology, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
| | - Kamran Majeed
- School of Medicine, University of Western Australia, Perth 6009, Australia.,Department of Cardiology, Waikato District Health Board, Hamilton 3204, New Zealand
| | - Fiona Pixley
- School of Biomedical Sciences, Pharmacology and Toxicology, University of Western Australia, Perth 6009, Australia
| | - Graham Scott Hillis
- School of Medicine, University of Western Australia, Perth 6009, Australia.,Department of Cardiology, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
| | - Roslyn Jane Francis
- School of Medicine, University of Western Australia, Perth 6009, Australia.,Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth 6009, Australia
| | - Carl Johann Schultz
- School of Medicine, University of Western Australia, Perth 6009, Australia.,Department of Cardiology, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia
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Bellinge JW, Francis RJ, Lee SC, Bondonno NP, Sim M, Lewis JR, Watts GF, Schultz CJ. The effect of vitamin K1 on arterial calcification activity in subjects with diabetes mellitus: a post hoc analysis of a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr 2022; 115:45-52. [PMID: 34637494 DOI: 10.1093/ajcn/nqab306] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/02/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Coronary and aortic artery calcifications are generally slow to develop, and their burden predicts cardiovascular disease events. In patients with diabetes mellitus, arterial calcification is accelerated and calcification activity can be detected using 18F-sodium fluoride positron emission tomography (18F-NaF PET). OBJECTIVES We aimed to determine whether vitamin K1 supplementation inhibits arterial calcification activity in individuals with diabetes mellitus. METHODS This was a post hoc analysis of the ViKCoVaC (effect of Vitamin-K1 and Colchicine on Vascular Calcification activity in subjects with Diabetes Mellitus) double-blind randomized controlled trial conducted in Perth, Western Australia. Individuals with diabetes mellitus and established coronary calcification (coronary calcium score > 10), but without clinical coronary artery disease, underwent baseline 18F-NaF PET imaging, followed by oral vitamin K1 supplementation (10 mg/d) or placebo for 3 mo, after which 18F-NaF PET imaging was repeated. We tested whether individuals randomly assigned to vitamin K1 supplementation had reduced development of new 18F-NaF PET positive lesions within the coronary arteries and aorta. RESULTS In total, 149 individuals completed baseline and follow-up imaging studies. Vitamin K1 supplementation independently decreased the odds of developing new 18F-NaF PET positive lesions in the coronary arteries (OR: 0.35; 95% CI: 0.16, 0.78; P = 0.010), aorta (OR: 0.27; 95% CI: 0.08, 0.94; P = 0.040), and in both aortic and coronary arteries (OR: 0.28; 95% CI: 0.13, 0.63; P = 0.002). CONCLUSIONS In individuals with diabetes mellitus, supplementation with 10 mg vitamin K1/d may prevent the development of newly calcifying lesions within the aorta and the coronary arteries as detected using 18F-NaF PET. Further long-term studies are needed to test this hypothesis.This trial was registered at anzctr.org.au as ACTRN12616000024448.
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Affiliation(s)
- Jamie W Bellinge
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Roslyn J Francis
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sing C Lee
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Nicola P Bondonno
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.,School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Marc Sim
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Joshua R Lewis
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.,Centre for Kidney Research, Children's Hospital Westmead, School of Public Health, University of Sydney, Westmead, New South Wales, Australia
| | - Gerald F Watts
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Carl J Schultz
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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Coronary plaque instability assessed by positron emission tomography and optical coherence tomography. Ann Nucl Med 2021; 35:1136-1146. [PMID: 34273103 PMCID: PMC8408060 DOI: 10.1007/s12149-021-01651-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 06/27/2021] [Indexed: 11/10/2022]
Abstract
Background Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) are caused often by destabilization of non-flow limiting inflamed coronary artery plaques. 18F-fluorodeoxyglucose (FDG) uptake with positron emission tomography/computed tomography (PET/CT) reveals plaque inflammation, while intracoronary optical coherence tomography (OCT) reliably identifies morphological features of coronary instability, such as plaque rupture or erosion. We aimed to prospectively compare these two innovative biotechnologies in the characterization of coronary artery inflammation, which has never been attempted before. Methods OCT and FDG PET/CT were performed in 18 patients with single vessel coronary artery disease, treated by percutaneous coronary intervention (PCI) with stent implantation, divided into 2 groups: NSTEMI/UA (n = 10) and stable angina (n = 8) patients. Results Plaque rupture/erosion recurred more frequently [100% vs 25%, p = 0.001] and FDG uptake was greater [TBR median 1.50 vs 0.87, p = 0.004] in NSTEMI/UA than stable angina patients. FDG uptake resulted greater in patients with than without plaque rupture/erosion [1.2 (0.86–1.96) vs 0.87 (0.66–1.07), p = 0.013]. Among NSTEMI/UA patients, no significant difference in FDG uptake was found between ruptured and eroded plaques. The highest FDG uptake values were found in ruptured plaques, belonging to patients with NSTEMI/UA. OCT and PET/CT agreed in 72% of patients [p = 0.018]: 100% of patients with plaque rupture/erosion and increased FDG uptake had NSTEMI/UA. Conclusion For the first time, we demonstrated that the correspondence between increased FDG uptake with PET/CT and morphology of coronary plaque instability at OCT is high.
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Kelsey LJ, Bellinge JW, Majeed K, Parker LP, Richards S, Schultz CJ, Doyle BJ. Low Endothelial Shear Stress Is Associated With High-Risk Coronary Plaque Features and Microcalcification Activity. JACC Cardiovasc Imaging 2021; 14:2262-2264. [PMID: 34274284 DOI: 10.1016/j.jcmg.2021.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
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