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Peri-Coronary Adipose Tissue Density Is Associated With 18F-Sodium Fluoride Coronary Uptake in Stable Patients With High-Risk Plaques.
JACC Cardiovasc Imaging. 2019 10; 12(10):2000-2010.JC

Abstract

OBJECTIVES

This study aimed to assess the association between increased lesion peri-coronary adipose tissue (PCAT) density and coronary 18F-sodium fluoride (18F-NaF) uptake on positron emission tomography (PET) in stable patients with high-risk coronary plaques (HRPs) shown on coronary computed tomography angiography (CTA).

BACKGROUND

Coronary 18F-NaF uptake reflects the rate of calcification of coronary atherosclerotic plaque. Increased PCAT density is associated with vascular inflammation. Currently, the relationship between increased PCAT density and 18F-NaF uptake in stable patients with HRPs on coronary CTA has not been characterized.

METHODS

Patients who underwent coronary CTA were screened for HRP, which was defined by 3 concurrent plaque features: positive remodeling; low attenuation plaque (LAP) (<30 Hounsfield units [HU]) and spotty calcification; and obstructive coronary stenosis ≥50% (plaque volume >100 mm3). Patients with HRPs were recruited to undergo 18F-NaF PET/CT. In lesions with stenosis ≥25%, quantitative plaque analysis, mean PCAT density, maximal coronary motion-corrected 18F-NaF standard uptake values (SUVmax), and target-to-background ratios (TBR) were measured.

RESULTS

Forty-one patients (age 65 ± 6 years; 68% men) were recruited. Fifty-one lesions in 23 patients (56%) showed increased coronary 18F-NaF activity. Lesions with 18F-NaF uptake had higher surrounding PCAT density than those without 18F-NaF uptake (-73 HU; interquartile range -79 to -68 HU vs. -86 HU; interquartile range -94 to -80 HU; p < 0.001). 18F-NaF TBR and SUVmax were correlated with PCAT density (r = 0.63 and r = 0.68, respectively; all p < 0.001). On adjusted multiple regression analysis, increased lesion PCAT density and LAP volume were associated with 18F-NaF TBR (β = 0.25; 95% confidence interval: 0.17 to 0.34; p < 0.001 for PCAT, and β = 0.07; 95% confidence interval: 0.03 to 0.11; p = 0.002 for LAP).

CONCLUSIONS

In patients with HRP features on coronary CTA, increased density of PCAT was associated with focal 18F-NaF PET uptake. Simultaneous assessment of these imaging biomarkers by 18F-NaF PET and CTA might refine cardiovascular risk prediction in stable patients with HRP features.

Authors+Show Affiliations

Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California; BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California.Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: Daniel.Berman@cshs.org.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30772226

Citation

Kwiecinski, Jacek, et al. "Peri-Coronary Adipose Tissue Density Is Associated With 18F-Sodium Fluoride Coronary Uptake in Stable Patients With High-Risk Plaques." JACC. Cardiovascular Imaging, vol. 12, no. 10, 2019, pp. 2000-2010.
Kwiecinski J, Dey D, Cadet S, et al. Peri-Coronary Adipose Tissue Density Is Associated With 18F-Sodium Fluoride Coronary Uptake in Stable Patients With High-Risk Plaques. JACC Cardiovasc Imaging. 2019;12(10):2000-2010.
Kwiecinski, J., Dey, D., Cadet, S., Lee, S. E., Otaki, Y., Huynh, P. T., Doris, M. K., Eisenberg, E., Yun, M., Jansen, M. A., Williams, M. C., Tamarappoo, B. K., Friedman, J. D., Dweck, M. R., Newby, D. E., Chang, H. J., Slomka, P. J., & Berman, D. S. (2019). Peri-Coronary Adipose Tissue Density Is Associated With 18F-Sodium Fluoride Coronary Uptake in Stable Patients With High-Risk Plaques. JACC. Cardiovascular Imaging, 12(10), 2000-2010. https://doi.org/10.1016/j.jcmg.2018.11.032
Kwiecinski J, et al. Peri-Coronary Adipose Tissue Density Is Associated With 18F-Sodium Fluoride Coronary Uptake in Stable Patients With High-Risk Plaques. JACC Cardiovasc Imaging. 2019;12(10):2000-2010. PubMed PMID: 30772226.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peri-Coronary Adipose Tissue Density Is Associated With 18F-Sodium Fluoride Coronary Uptake in Stable Patients With High-Risk Plaques. AU - Kwiecinski,Jacek, AU - Dey,Damini, AU - Cadet,Sebastien, AU - Lee,Sang-Eun, AU - Otaki,Yuka, AU - Huynh,Phi T, AU - Doris,Mhairi K, AU - Eisenberg,Evann, AU - Yun,Mijin, AU - Jansen,Maurits A, AU - Williams,Michelle C, AU - Tamarappoo,Balaji K, AU - Friedman,John D, AU - Dweck,Marc R, AU - Newby,David E, AU - Chang,Hyuk-Jae, AU - Slomka,Piotr J, AU - Berman,Daniel S, Y1 - 2019/02/13/ PY - 2018/09/28/received PY - 2018/11/12/revised PY - 2018/11/15/accepted PY - 2019/2/18/pubmed PY - 2020/7/14/medline PY - 2019/2/18/entrez KW - (18)F-sodium fluoride KW - PET/CT KW - coronary computed tomography angiography KW - coronary imaging KW - high-risk plaque KW - peri-coronary adipose tissue density SP - 2000 EP - 2010 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 12 IS - 10 N2 - OBJECTIVES: This study aimed to assess the association between increased lesion peri-coronary adipose tissue (PCAT) density and coronary 18F-sodium fluoride (18F-NaF) uptake on positron emission tomography (PET) in stable patients with high-risk coronary plaques (HRPs) shown on coronary computed tomography angiography (CTA). BACKGROUND: Coronary 18F-NaF uptake reflects the rate of calcification of coronary atherosclerotic plaque. Increased PCAT density is associated with vascular inflammation. Currently, the relationship between increased PCAT density and 18F-NaF uptake in stable patients with HRPs on coronary CTA has not been characterized. METHODS: Patients who underwent coronary CTA were screened for HRP, which was defined by 3 concurrent plaque features: positive remodeling; low attenuation plaque (LAP) (<30 Hounsfield units [HU]) and spotty calcification; and obstructive coronary stenosis ≥50% (plaque volume >100 mm3). Patients with HRPs were recruited to undergo 18F-NaF PET/CT. In lesions with stenosis ≥25%, quantitative plaque analysis, mean PCAT density, maximal coronary motion-corrected 18F-NaF standard uptake values (SUVmax), and target-to-background ratios (TBR) were measured. RESULTS: Forty-one patients (age 65 ± 6 years; 68% men) were recruited. Fifty-one lesions in 23 patients (56%) showed increased coronary 18F-NaF activity. Lesions with 18F-NaF uptake had higher surrounding PCAT density than those without 18F-NaF uptake (-73 HU; interquartile range -79 to -68 HU vs. -86 HU; interquartile range -94 to -80 HU; p < 0.001). 18F-NaF TBR and SUVmax were correlated with PCAT density (r = 0.63 and r = 0.68, respectively; all p < 0.001). On adjusted multiple regression analysis, increased lesion PCAT density and LAP volume were associated with 18F-NaF TBR (β = 0.25; 95% confidence interval: 0.17 to 0.34; p < 0.001 for PCAT, and β = 0.07; 95% confidence interval: 0.03 to 0.11; p = 0.002 for LAP). CONCLUSIONS: In patients with HRP features on coronary CTA, increased density of PCAT was associated with focal 18F-NaF PET uptake. Simultaneous assessment of these imaging biomarkers by 18F-NaF PET and CTA might refine cardiovascular risk prediction in stable patients with HRP features. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/30772226/Peri_Coronary_Adipose_Tissue_Density_Is_Associated_With_18F_Sodium_Fluoride_Coronary_Uptake_in_Stable_Patients_With_High_Risk_Plaques_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(19)30076-2 DB - PRIME DP - Unbound Medicine ER -