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Peverelli M, Maughan RT, Gopalan D, Dweck MR, Dey D, Buch MH, Rudd JHF, Tarkin JM. Use of coronarycomputed tomography for cardiovascular risk assessment in immune-mediated inflammatory diseases. Heart 2024; 110:545-551. [PMID: 38238078 DOI: 10.1136/heartjnl-2022-321403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/05/2023] [Indexed: 02/15/2024] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs) are recognised risk factors for accelerated atherosclerotic cardiovascular disease (CVD), particularly in younger individuals and women who lack traditional CVD risk factors. Reflective of the critical role that inflammation plays in the formation, progression and rupture of atherosclerotic plaques, research into immune mechanisms of CVD has led to the identification of a range of therapeutic targets that are the subject of ongoing clinical trials. Several key inflammatory pathways implicated in the pathogenesis of atherosclerosis are targeted in people with IMIDs. However, cardiovascular risk continues to be systematically underestimated by conventional risk assessment tools in the IMID population, resulting in considerable excess CVD burden and mortality. Hence, there is a pressing need to improve methods for CVD risk-stratification among patients with IMIDs, to better guide the use of statins and other prognostic interventions. CT coronary angiography (CTCA) is the current first-line investigation for diagnosing and assessing the severity of coronary atherosclerosis in many individuals with suspected angina. Whether CTCA is also useful in the general population for reclassifying asymptomatic individuals and improving long-term prognosis remains unknown. However, in the context of IMIDs, it is conceivable that the information provided by CTCA, including state-of-the-art assessments of coronary plaque, could be an important clinical adjunct in this high-risk patient population. This narrative review discusses the current literature about the use of coronary CT for CVD risk-stratification in three of the most common IMIDs including rheumatoid arthritis, psoriasis and systemic lupus erythematosus.
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Affiliation(s)
- Marta Peverelli
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | | | - Deepa Gopalan
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
- Department of Radiology, Cambridge University Hospitals NHS Trust, UK
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Damini Dey
- Departments of Biomedical Sciences and Medicine, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Maya H Buch
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - James H F Rudd
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Jason M Tarkin
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
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Wall C, Weir-McCall J, Tweed K, Hoole SP, Gopalan D, Huang Y, Corovic A, Peverelli M, Dey D, Bennett MR, Rudd JHF, Kydd A, Bhagra S, Tarkin JM. CT pericoronary adipose tissue density predicts coronary allograft vasculopathy and adverse clinical outcomes after cardiac transplantation. Eur Heart J Cardiovasc Imaging 2024:jeae069. [PMID: 38493483 DOI: 10.1093/ehjci/jeae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
AIMS To assess pericoronary adipose tissue (PCAT) density on Coronary Computed Tomography Angiography (CCTA) as a marker of inflammatory disease activity in coronary allograft vasculopathy (CAV). METHODS AND RESULTS PCAT density, lesion volumes, and total vessel volume-to-myocardial mass ratio (V/M) were retrospectively measured in 126 CCTAs from 94 heart transplant patients (mean age 49 [SD 14.5] years, 40% female) who underwent imaging between 2010 to 2021; age and sex-matched controls; and patients with atherosclerosis. PCAT density was higher in transplant patients with CAV (n = 40; -73.0 HU [SD 9.3]) than without CAV (n = 86; -77.9 HU [SD 8.2]), and controls (n = 12; -86.2 HU [SD 5.4]), p < 0.01 for both. Unlike patients with atherosclerotic coronary artery disease (n = 32), CAV lesions were predominantly non-calcified, comprised of mostly fibrous or fibrofatty tissue. V/M was lower in patients with CAV than without (32.4 mm3/g [SD 9.7] vs. 41.4 mm3/g [SD 12.3], p < 0.0001). PCAT density and V/M improved the ability to predict CAV from AUC 0.75 to 0.85 when added to donor age and donor hypertension status (p < 0.0001). PCAT density above -66 HU was associated with a greater incidence of all-cause mortality (OR 18.0 [95%CI 3.25-99.6], p < 0.01) and the composite endpoint of death, CAV progression, acute rejection, and coronary revascularization (OR 7.47 [95%CI 1.8-31.6], p = 0.01) over 5.3 (SD 2.1) years. CONCLUSIONS Heart transplant patients with CAV have higher PCAT density and lower V/M than those without. Increased PCAT density is associated with adverse clinical outcomes. These CCTA metrics could be useful for diagnosis and monitoring of CAV severity.
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Affiliation(s)
- Christopher Wall
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan Weir-McCall
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Katharine Tweed
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Stephen P Hoole
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Deepa Gopalan
- Department of Radiology, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Yuan Huang
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Andrej Corovic
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Marta Peverelli
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Damini Dey
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, California
| | - Martin R Bennett
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - James H F Rudd
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Anna Kydd
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Sai Bhagra
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Jason M Tarkin
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
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3
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Ćorović A, Wall C, Nus M, Gopalan D, Huang Y, Imaz M, Zulcinski M, Peverelli M, Uryga A, Lambert J, Bressan D, Maughan RT, Pericleous C, Dubash S, Jordan N, Jayne DR, Hoole SP, Calvert PA, Dean AF, Rassl D, Barwick T, Iles M, Frontini M, Hannon G, Manavaki R, Fryer TD, Aloj L, Graves MJ, Gilbert FJ, Dweck MR, Newby DE, Fayad ZA, Reynolds G, Morgan AW, Aboagye EO, Davenport AP, Jørgensen HF, Mallat Z, Bennett MR, Peters JE, Rudd JHF, Mason JC, Tarkin JM. Somatostatin Receptor PET/MR Imaging of Inflammation in Patients With Large Vessel Vasculitis and Atherosclerosis. J Am Coll Cardiol 2023; 81:336-354. [PMID: 36697134 PMCID: PMC9883634 DOI: 10.1016/j.jacc.2022.10.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/03/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Assessing inflammatory disease activity in large vessel vasculitis (LVV) can be challenging by conventional measures. OBJECTIVES We aimed to investigate somatostatin receptor 2 (SST2) as a novel inflammation-specific molecular imaging target in LVV. METHODS In a prospective, observational cohort study, in vivo arterial SST2 expression was assessed by positron emission tomography/magnetic resonance imaging (PET/MRI) using 68Ga-DOTATATE and 18F-FET-βAG-TOCA. Ex vivo mapping of the imaging target was performed using immunofluorescence microscopy; imaging mass cytometry; and bulk, single-cell, and single-nucleus RNA sequencing. RESULTS Sixty-one participants (LVV: n = 27; recent atherosclerotic myocardial infarction of ≤2 weeks: n = 25; control subjects with an oncologic indication for imaging: n = 9) were included. Index vessel SST2 maximum tissue-to-blood ratio was 61.8% (P < 0.0001) higher in active/grumbling LVV than inactive LVV and 34.6% (P = 0.0002) higher than myocardial infarction, with good diagnostic accuracy (area under the curve: ≥0.86; P < 0.001 for both). Arterial SST2 signal was not elevated in any of the control subjects. SST2 PET/MRI was generally consistent with 18F-fluorodeoxyglucose PET/computed tomography imaging in LVV patients with contemporaneous clinical scans but with very low background signal in the brain and heart, allowing for unimpeded assessment of nearby coronary, myocardial, and intracranial artery involvement. Clinically effective treatment for LVV was associated with a 0.49 ± 0.24 (standard error of the mean [SEM]) (P = 0.04; 22.3%) reduction in the SST2 maximum tissue-to-blood ratio after 9.3 ± 3.2 months. SST2 expression was localized to macrophages, pericytes, and perivascular adipocytes in vasculitis specimens, with specific receptor binding confirmed by autoradiography. SSTR2-expressing macrophages coexpressed proinflammatory markers. CONCLUSIONS SST2 PET/MRI holds major promise for diagnosis and therapeutic monitoring in LVV. (PET Imaging of Giant Cell and Takayasu Arteritis [PITA], NCT04071691; Residual Inflammation and Plaque Progression Long-Term Evaluation [RIPPLE], NCT04073810).
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Affiliation(s)
- Andrej Ćorović
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Christopher Wall
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Meritxell Nus
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Deepa Gopalan
- Department of Radiology, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom; Department of Radiology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Yuan Huang
- Engineering and Physical Sciences Research Council Centre for Mathematical Imaging in Healthcare, University of Cambridge, Cambridge, United Kingdom
| | - Maria Imaz
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Michal Zulcinski
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Marta Peverelli
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom; Vascular Sciences, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Anna Uryga
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jordi Lambert
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Dario Bressan
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - Robert T Maughan
- Vascular Sciences, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Charis Pericleous
- Vascular Sciences, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Suraiya Dubash
- Department of Oncology, University College London NHS Trust, London, United Kingdom; Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Natasha Jordan
- Department of Rheumatology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - David R Jayne
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Stephen P Hoole
- Department of Cardiology, Royal Papworth Hospital NHS Trust, Cambridge, United Kingdom
| | - Patrick A Calvert
- Department of Cardiology, Royal Papworth Hospital NHS Trust, Cambridge, United Kingdom
| | - Andrew F Dean
- Department of Histopathology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Doris Rassl
- Department of Histopathology, Royal Papworth Hospital NHS Trust, Cambridge, United Kingdom
| | - Tara Barwick
- Department of Radiology, Imperial College Healthcare National Health Service (NHS) Trust, London, United Kingdom; Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Mark Iles
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Mattia Frontini
- Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, United Kingdom
| | - Greg Hannon
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - Roido Manavaki
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Luigi Aloj
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Zahi A Fayad
- BioMedical Engineering & Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gary Reynolds
- Department of Rheumatology, University of Newcastle, Newcastle, United Kingdom
| | - Ann W Morgan
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Eric O Aboagye
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Anthony P Davenport
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Helle F Jørgensen
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ziad Mallat
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Martin R Bennett
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - James E Peters
- Centre for Inflammatory Disease, Imperial College London, London, United Kingdom
| | - James H F Rudd
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Justin C Mason
- Vascular Sciences, National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Jason M Tarkin
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, United Kingdom; Vascular Sciences, National Heart & Lung Institute, Imperial College London, London, United Kingdom.
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Ćorović A, Gopalan D, Wall C, Peverelli M, Hoole SP, Calvert PA, Manavaki R, Fryer TD, Aloj L, Graves MJ, Bennett MR, Rudd JH, Tarkin JM. Novel Approach for Assessing Postinfarct Myocardial Injury and Inflammation Using Hybrid Somatostatin Receptor Positron Emission Tomography/Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2023; 16:e014538. [PMID: 36649455 PMCID: PMC9848209 DOI: 10.1161/circimaging.122.014538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Andrej Ćorović
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
| | - Deepa Gopalan
- Department of Radiology, Cambridge University Hospitals NHS Trust, United Kingdom (D.G.)
| | - Christopher Wall
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
| | - Marta Peverelli
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
| | - Stephen P. Hoole
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
- Department of Cardiology, Royal Papworth Hospital NHS Trust, United Kingdom (S.P.H., P.A.C.)
| | - Patrick A. Calvert
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
- Department of Cardiology, Royal Papworth Hospital NHS Trust, United Kingdom (S.P.H., P.A.C.)
| | - Roido Manavaki
- Department of Radiology (R.M., L.A., M.J.G.), University of Cambridge, United Kingdom
| | - Tim D. Fryer
- Department of Clinical Neurosciences (T.D.F.), University of Cambridge, United Kingdom
| | - Luigi Aloj
- Department of Radiology (R.M., L.A., M.J.G.), University of Cambridge, United Kingdom
| | - Martin J. Graves
- Department of Radiology (R.M., L.A., M.J.G.), University of Cambridge, United Kingdom
| | - Martin R. Bennett
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
| | - James H.F. Rudd
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
| | - Jason M. Tarkin
- Section of CardioRespiratory Medicine (A.C., C.W., M.P., S.P.H., P.A.C., M.R.B., J.H.F.R., J.M.T.), University of Cambridge, United Kingdom
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5
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Corovic A, Nus M, Peverelli M, Gopalan D, Calvert PA, Hoole SP, Manavaki R, Fryer T, Aloj L, Graves MJ, Dweck MR, Newby DE, Mallat Z, Rudd JHF, Tarkin JM. Imaging of post-infarct myocardial inflammation with 68Ga-DOTATATE PET/MRI. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
After myocardial infarction (MI), inflammation and its resolution modulate the extent of myocardial damage. 68Ga-DOTATATE is a PET tracer that binds to somatostatin receptor 2 (SST2), which is up-regulated in pro-inflammatory macrophages [1].
Purpose
We investigated 68Ga-DOTATATE PET/MRI for quantifying post-infarct myocardial inflammation.
Methods
In this prospective observational cohort study, participants with MI underwent 68Ga-DOTATATE PET/MRI at baseline (t0: <2 weeks post-MI) and 3 months (t3M). Patients with prior MI, heart failure, coronary revascularisation, or contraindication to PET/MRI, were excluded. Blood samples were taken at the time of imaging for high sensitivity CRP (hsCRP), high sensitivity troponin I (hsTnI), NTproBNP and peripheral blood monocyte subset counts measured by mass cytometry. 68Ga-DOTATATE maximum Standardised Uptake Values (SUV) and Tissue-to-Background Ratios (TBR) adjusted for blood pool activity were compared in the infarct defined by late gadolinium enhancement (LGE) MRI to remote myocardium at t0 and t3M.
Results
Thirty-two patients (mean age 59 [SD 9] years; 26 [81%] male and 6 [19%] female), comprised of 18 (56%) patients with ST elevation MI and 14 (44%) with non-ST elevation MI, were enrolled. Mean peak troponin was 16,953ng/L (range 408 to >25,000ng/L), and 16 (52%) patients had left ventricular impairment (ejection fraction <50%).
68Ga-DOTATATE PET signal co-localised with myocardial LGE and focal oedema (arrows) on T2-weighted MRI (Fig. 1; asterisk: culprit artery) and had excellent ability to discriminate infarct from remote regions (t0: infarct SUV 2.41 vs. remote 1.58, p<0.0001; t0: infarct TBR 5.08 vs. 3.35, p<0.0001; Fig. 2a).
At 100 (SD 13) days after MI (n=23 patients), residual 68Ga-DOTATATE uptake in the infarct remained higher than remote myocardium (t3M: infarct SUV 1.88 vs. remote 1.27, p<0.0001; t3M: infarct TBR 3.96 vs. remote 2.73, p<0.0001), but was reduced compared to baseline (SUV −22%, p<0.0001; TBR −22%, p=0.002; Fig. 2b).
Reduction in infarct 68Ga-DOTATATE uptake was consistent with overall decreases in hsCRP (2.16 vs. 8.76 mg/L), hsTnI (19 vs. 1365 ng/L) and NTproBNP (372 vs. 959 pg/mL) at t3M vs. t0 (n=23, all p<0.05). Focal oedema on MRI was resolved in 17 (74%) patients at t3M. Infarct-to-remote TBR ratio at t0 was correlated with hsTnI (r=0.35, p<0.05). At t3M (n=9 samples) vs t0 (n=20 samples), there was a reduction in % classical-to-non-classical ratio of peripheral monocytes (mean 6.5 [SD 3.8] vs. 14.4 [SD 11.2], p=0.005).
Conclusions
This is the first prospective study of serial 68Ga-DOTATATE PET/MRI in patients after MI. Here we show that 68Ga-DOTATATE tracks resolving myocardial inflammation. Ongoing work as part of this study seeks to confirm the cellular origin of infarct-related 68Ga-DOTATATE PET signal and SST2 expression within inflamed myocardial tissue, and test its longer-term association with ischaemic myocardial remodelling.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Wellcome TrustBritish Heart Foundation
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Affiliation(s)
- A Corovic
- University of Cambridge , Cambridge , United Kingdom
| | - M Nus
- University of Cambridge , Cambridge , United Kingdom
| | - M Peverelli
- University of Cambridge , Cambridge , United Kingdom
| | - D Gopalan
- Cambridge University Hospitals NHS Foundation Trust , Cambridge , United Kingdom
| | - P A Calvert
- Royal Papworth Hospital NHS Foundation Trust , Cambridge , United Kingdom
| | - S P Hoole
- Royal Papworth Hospital NHS Foundation Trust , Cambridge , United Kingdom
| | - R Manavaki
- University of Cambridge , Cambridge , United Kingdom
| | - T Fryer
- University of Cambridge , Cambridge , United Kingdom
| | - L Aloj
- University of Cambridge , Cambridge , United Kingdom
| | - M J Graves
- University of Cambridge , Cambridge , United Kingdom
| | - M R Dweck
- University of Edinburgh , Edinburgh , United Kingdom
| | - D E Newby
- University of Edinburgh , Edinburgh , United Kingdom
| | - Z Mallat
- University of Cambridge , Cambridge , United Kingdom
| | - J H F Rudd
- University of Cambridge , Cambridge , United Kingdom
| | - J M Tarkin
- University of Cambridge , Cambridge , United Kingdom
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Bambrough P, Peverelli M, Brown AJ, Giblett JP, Bennett MR, West NEJ, Hoole SP. Trans-Myocardial Blood Interleukin-6 Levels Relate to Intracoronary Imaging-Defined Features of Plaque Vulnerability and Predict Procedure-Induced Myocardial Infarction. Cardiovasc Revasc Med 2022; 39:6-11. [PMID: 34670726 DOI: 10.1016/j.carrev.2021.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/07/2021] [Accepted: 10/07/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Intravascular imaging has defined various vulnerable plaque (VP) phenotypes that predict future clinical events. Atherosclerosis is an inflammatory process and inflammation, measured by systemic biomarkers can also predict events and anti-inflammatory therapy is beneficial. We were interested to assess the relationship between plaque phenotypes and key inflammatory biomarkers, measured close to the coronary. METHODS Ninety-two patients scheduled for elective percutaneous coronary intervention (PCI) underwent virtual histology intravascular ultrasound, optical coherence tomography, pressure wire and blood sampling from the guide catheter (GC), coronary sinus (CS) to determine trans-myocardial gradient (TMG = CS-GC) and from peripheral blood. Procedure related troponin release was assessed at 6-hours post-PCI from peripheral venous blood. Biomarker data were analysed and compared with coronary data. RESULTS Interleukin (IL)-6 was associated with increased levels of tumour necrosis factor (TNF)-α and C-reactive protein (CRP) and the pre-PCI IL-6 TMG correlated with plaque features of vulnerability: plaque burden - PB (r = 0.253, p = 0.04) and minimal lumen area - MLA (r = -0.438, p = 0.007), although no relationship existed for thin-capped fibroatheroma defined by either imaging modality. Peripheral IL-6 levels had no correlation with post PCI troponin, although the pre-PCI IL-6 TMG was related (r = 0.334, p = 0.006), as was PB (r = 0.27, p = 0.029). CONCLUSION IL-6 TMG pre-PCI correlates with plaque burden and MLA that have been shown to predict future clinical events and is correlated with post-PCI troponin release. These associations were not apparent from peripheral blood and suggest that local coronary biomarker signatures may help further define vulnerability and risk.
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Affiliation(s)
- Paul Bambrough
- Interventional Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Marta Peverelli
- Interventional Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Adam J Brown
- Interventional Cardiology, Monash University, Melbourne, Australia
| | - Joel P Giblett
- Interventional Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Nicholas E J West
- Interventional Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Stephen P Hoole
- Interventional Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
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Farag M, Kiberu Y, Ashwin Reddy S, Shoaib A, Egred M, Krishnan U, Fares M, Peverelli M, Gorog DA, Elmahdy W, Berman M, Osman M. Preoperative Atrial Fibrillation is associated with long-term morTality in patients undergoing suRgical AortiC valvE Replacement. J Card Surg 2021; 36:3561-3566. [PMID: 34309884 DOI: 10.1111/jocs.15844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is frequent after any cardiac surgery, but evidence suggests it may have no significant impact on survival if sinus rhythm (SR) is effectively restored early after the onset of the arrhythmia. In contrast, management of preoperative AF is often overlooked during or after cardiac surgery despite several proposed protocols. This study sought to evaluate the impact of preoperative AF on mortality in patients undergoing isolated surgical aortic valve replacement (AVR). METHODS We performed a retrospective, single-center study involving 2628 consecutive patients undergoing elective, primary isolated surgical AVR from 2008 to 2018. A total of 268/2628 patients (10.1%) exhibited AF before surgery. The effect of preoperative AF on mortality was evaluated with univariate and multivariate analyses. RESULTS Short-term mortality was 0.8% and was not different between preoperative AF and SR cohorts. Preoperative AF was highly predictive of long-term mortality (median follow-up of 4 years [Q1-Q3 2-7]; hazard ratio [HR]: 2.24, 95% confidence interval [CI]: 1.79-2.79, p < .001), and remained strongly and independently predictive after adjustment for other risk factors (HR: 1.54, 95% CI: 1.21-1.96, p < .001) compared with preoperative SR. In propensity score-matched analysis, the adjusted mortality risk was higher in the AF cohort (OR: 1.47, 95% CI: 1.04-1.99, p = .03) compared with the SR cohort. CONCLUSIONS Preoperative AF was independently predictive of long-term mortality in patients undergoing isolated surgical AVR. It remains to be seen whether concomitant surgery or other preoperative measures to correct AF may impact long-term survival.
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Affiliation(s)
- Mohamed Farag
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
| | - Yusuf Kiberu
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - S Ashwin Reddy
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Mohaned Egred
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Unni Krishnan
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Mina Fares
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Diana A Gorog
- Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
| | - Walid Elmahdy
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Marius Berman
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Mohamed Osman
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,National Heart Institute, Giza, Egypt
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8
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Peverelli M, Reddy A, Hughes ML. A Patient With Congenital Heart Disease, Presenting With Angina. JAMA Cardiol 2021; 6:e206940. [PMID: 33555299 DOI: 10.1001/jamacardio.2020.6940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Marta Peverelli
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Ashwin Reddy
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Marina L Hughes
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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9
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Di Saverio S, Peverelli M, Stupalkowska W, Rizzuto A, De Luca R, Wheeler J. Scarless, entirely laparoscopic panproctocolectomy and extrasphincteric dissection with perineal extraction of the specimen for cancer of the anorectal junction - a video vignette. Colorectal Dis 2020; 22:1780-1782. [PMID: 32533879 DOI: 10.1111/codi.15188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/14/2020] [Indexed: 02/08/2023]
Affiliation(s)
- S Di Saverio
- Department of General Surgery, University Hospital of Varese, ASST Sette Laghi, University of Insubria, Varese, Italy.,Colorectal Surgery Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - M Peverelli
- Colorectal Surgery Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - W Stupalkowska
- Colorectal Surgery Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - A Rizzuto
- Department of Surgery, University of Magna Greacia, Catanzaro, Italy
| | - R De Luca
- Department Surgical Oncology, IRCCS Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - J Wheeler
- Colorectal Surgery Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
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10
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Gori S, Ruffino M, Peverelli M, Molteni M, Priftis K, Facoetti A. Non-spatial attention engagement in Neglect patients. J Vis 2010. [DOI: 10.1167/10.7.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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