18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial

Joshi, Nikhil; Vesey, Alex; Williams, Michelle; Shah, Anoop; Calvert, Patrick A.; Craighead, Felicity; Yeoh, Su Ern; Wallace, William; Salter, Donald; Fletcher, Alison; Beek, Edwin Jacques Rudolph van; Flapan, Andrew D.; Uren, Neal; Behan, Miles; Cruden, Nicholas L.; Mills, Nicholas L; Fox, Keith A.A.; Rudd, James H.F.; Dweck, Marc R; Newby, David E.

doi:10.1016/s0140-6736(13)61754-7

Cited by 826 publications

(749 citation statements)

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“…The exposed hydroxyapatite crystal surface area in the arterial wall and early active vascular calcification is below the resolution of CT, but the evolving powdery microcalcification is readily identified by 18 F‐NaF (Figure 3). 22, 98, 106 Dweck et al106 investigated histological markers of active calcification (ie, tissue nonspecific alkaline phosphatase and osteocalcin) in aortic stenosis and found a strong correlation between 18 F‐NaF uptake and these markers, thus confirming that 18 F‐NaF PET imaging provides information about the activity of calcification and might differentiate biologically active calcification from stable calcification. Alizarin Red staining also confirmed 18 F‐NaF uptake in areas of microcalcification17 (Figure 4).…”

Section: Positron Emission Tomographymentioning

confidence: 97%

“…An illustration of this pathophysiologic progression and current imaging techniques for vascular calcification are portrayed in Figures 1 and 2 16, 18, 19, 20, 21, 22, 23…”

Section: Atherosclerosis Development Calcification and Progressionmentioning

confidence: 99%

Section: Atherosclerosis Development Calcification and Progressionmentioning

confidence: 99%

“…Recently, substantial attention has been given to using 18 F‐NaF to investigate vascular calcification in the coronary arteries,22, 64 the aorta,99 and the carotid arteries,100 and it has rapidly gained acceptance as a useful tool for the investigation of plaque pathobiology.…”

Section: Positron Emission Tomographymentioning

confidence: 99%

“…Group mean data (E) demonstrate that 18 F‐fluoride activity in the culprit lesions is higher than that in non‐culprit vessels. Reprinted from Joshi et al22 with permission. Copyright ©2014, Elsevier Inc.…”

Section: Positron Emission Tomographymentioning

confidence: 99%

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Imaging Cardiovascular Calcification

Wang

Osborne

Tung

et al. 2018

JAHA

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Section: Positron Emission Tomographymentioning

confidence: 97%

“…An illustration of this pathophysiologic progression and current imaging techniques for vascular calcification are portrayed in Figures 1 and 2 16, 18, 19, 20, 21, 22, 23…”

Section: Atherosclerosis Development Calcification and Progressionmentioning

confidence: 99%

Section: Atherosclerosis Development Calcification and Progressionmentioning

confidence: 99%

Section: Positron Emission Tomographymentioning

confidence: 99%

Section: Positron Emission Tomographymentioning

confidence: 99%

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Imaging Cardiovascular Calcification

Wang

Osborne

Tung

et al. 2018

JAHA

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Updates on Acute Coronary Syndrome

2016

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Coronary Atherosclerotic Plaque Activity and Future Coronary Events

et al. 2023

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ImportanceRecurrent 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.ObjectiveTo 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 ParticipantsThis 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.InterventionCoronary 18F-sodium fluoride positron emission tomography and coronary computed tomography angiography.Main Outcomes and MeasuresTotal 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.ResultsAmong 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 RelevanceIn 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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18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial

Abstract: Chief Scientist Office Scotland and British Heart Foundation.

Cited by 826 publications

References 33 publications

Imaging Cardiovascular Calcification

Imaging Cardiovascular Calcification

Updates on Acute Coronary Syndrome

Coronary Atherosclerotic Plaque Activity and Future Coronary Events

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