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Assessment of Calcification and Inflammation with Positron Emission Tomography in Aortic Stenosis and Atherosclerosis

Lancet(2013)

Univ Edinburgh | Univ Cambridge

Cited 2|Views21
Abstract
Background Calcifi cation and infl ammation are key pathological processes in aortic stenosis and atherosclerosis.Using combined positron emission tomography and computed tomography (PET/CT), we sought to investigate their contribution to disease progression in aortic stenosis and to help identify vulnerable atherosclerotic plaque.Methods In the fi rst part of the study patients with calcifi c aortic valve disease stenosis were prospectively compared with age-matched and sex-matched controls with normal valves.Aortic valve severity was determined at baseline and 1 year by echocardiography and CT calcium scoring.Calcifi cation and infl ammation in the valve were assessed by sodium 18-fl uoride (NaF) and 18-fl uorodeoxyglucose (FDG) uptake with PET.In the second part of the study NaF and FDG activity was assessed in the coronary arteries both in patients with stable coronary disease and in patients after myocardial infarction.Findings 101 patients with aortic stenosis were compared with 20 controls.Tracer activity (target to background ratio [TBR]) was higher in patients with aortic stenosis than in controls (mean NaF 2•87 [SD 0•82] vs 1•55 [0•17], FDG 1•58 [0•21] vs 1•30 [0•13]; both p<0•01).NaF uptake displayed a progressive rise with valve severity (r²=0•540) with a more modest increase observed for FDG (r²=0•218).Baseline NaF correlated closely with alkaline phosphatase staining on immunohistochemistry (r²=0•79) and was a better predictor of disease progression at 1 year (r²=0•44, n=20) than was FDG (r²=0•02) or baseline calcium score (r²=0•36, current best predictor).Increased NaF activity was observed in 45 (42%) of 106 patients with stable coronary atherosclerosis and was localised to individual coronary plaques.These patients had higher rates of previous major adverse cardiovascular events (p=0•016) and higher Framingham risk scores (p=0•011) than did patients without increased uptake .In patients after myocardial infarction (n=15) intense NaF activity was observed at the site of the culprit lesion, with increased uptake compared with the maximum uptake elsewhere in the coronary arteries (TBR median 1•56 [IQR 1•49-1•82] vs 1•23 [1•15-1•48], p=0•02).Interpretation In the valve, NaF holds promise in predicting aortic stenosis progression.In the coronary arteries it identifi es culprit plaque post myocardial infarction and stable patients at elevated cardiac risk.
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要点】:本研究通过PET/CT技术探讨了钙化和炎症在主动脉狭窄和动脉粥样硬化疾病进展中的作用,发现NaF对于预测主动脉狭窄的进展和识别易损斑块具有潜在价值。

方法】:研究分为两部分,第一部分采用PET技术,通过NaF和FDG的摄取评估了101名主动脉狭窄患者和20名正常瓣膜对照者的瓣膜钙化和炎症情况;第二部分评估了106名稳定型冠心病患者和15名心肌梗死后患者的冠状动脉中NaF和FDG的活性。

实验】:实验通过比较患者和对照的tracer activity (TBR),发现主动脉狭窄患者的NaF和FDG摄取高于正常对照,且NaF摄取与瓣膜严重程度呈正相关,与碱性磷酸酶染色有高度相关性,是疾病进展的更好预测因子。在稳定型冠心病患者中,增加的NaF活性与不良心血管事件的高发生率相关;在心肌梗死后患者中,NaF在罪犯病变部位的摄取显著增加。数据集名称未在摘要中提及。