Clinical implication of 18F-NaF PET/computed tomography indexes of aortic calcification in coronary artery disease patients: correlations with cardiovascular risk factors

Abstract

Objective Vascular calcification is known to be associated with cardiovascular risk factors. Recently, 18F-NaF PET has been reported to be effective for detecting early and active vascular calcification. In this study, correlations between 18F-NaF PET/computed tomography (CT) findings and cardiovascular risk factors were investigated in patients with suspected coronary artery disease. Patients and methods Forty patients with suspected coronary artery disease underwent 18F-NaF PET/CT. The maximum and overall burden of calcifying activity, and the overall burden of calcium deposition in the descending thoracic aorta (DTA) were measured on 18F-NaF PET/CT and they were compared with cardiovascular risk factors, particularly, with those related to metabolic syndrome. Results The maximum and overall burden of calcifying activity in DTA measured on 18F-NaF PET were significantly correlated with diabetes mellitus (P = 0.030 and 0.049, respectively) and serum HbA1c level (ρ = 0.433 and 0.344, respectively). In contrast, the overall burden of calcium deposition measured on CT was significantly correlated with hypertension (P < 0.001). The overall burden of calcium deposition was also significantly correlated with metabolic syndrome (P = 0.002) and 10-year cardiovascular disease risk score (P = 0.004) Conclusion 18F-NaF uptake is closely related to diabetes mellitus, whereas aortic calcification on CT is closely related to hypertension. Although 18F-NaF uptake in DTA can be a potential prognostic factor, aortic calcification on CT is a more significant prognostic factor for overall cardiovascular risk than 18F-NaF uptake.

Atherosclerosis Imaging with 18F-Sodium Fluoride PET

“…We found 35 eligible articles. Three on the aortic valve ( n = 3) and seven on methodology ( n = 7) were excluded based on the abovementioned criteria, leaving 25 dealing with the coronary arteries [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ], femoral artery [ 12 , 13 , 14 , 15 ], abdominal aorta [ 16 , 17 , 18 ], carotid arteries [ 19 , 20 ], thoracic aorta [ 21 ], and intracranial [ 22 ], renal [ 23 ], and penile arteries [ 24 ]. One study focused on the carotid and cerebral arteries [ 25 ], another on the carotids, the aortic arch, and coronary arteries [ 26 ], and a third on several major arteries [ 27 ].…”

“…One study focused on the carotid and cerebral arteries [ 25 ], another on the carotids, the aortic arch, and coronary arteries [ 26 ], and a third on several major arteries [ 27 ]. Below (and in Supplementary Materials Tables S1–S5 ), the literature is summarized in six sections before being debated in the discussion: Disease mechanisms and targeting [ 10 ], Early detection and prevalence of NaF uptake in the heart and major arteries [ 5 , 23 , 24 , 25 , 27 ], NaF uptake in vulnerable, high risk, and ruptured plaque [ 6 , 7 , 8 , 9 , 19 , 20 ], Influence of age, sex, and other factors on NaF uptake [ 3 , 16 , 22 ], Association between NaF uptake and cardiovascular risk factors [ 4 , 15 , 21 ], NaF uptake and disease progression [ 11 , 12 , 13 , 14 , 17 , 18 , 26 ]. …”

“…In the entire material of 86 healthy controls and 50 angina pectoris patients, the authors observed that SUVmean increased with age and BMI, regardless of gender [ 4 ]. In 40 patients with suspected coronary artery disease, including 17 (43%) with DM, Ryoo et al demonstrated that the burden of NaF in the descending thoracic aorta correlated significantly with DM and serum HbA1c level, whereas overall burden of CT-calcium deposition correlated with hypertension, metabolic syndrome, and 10-year CVD risk score [ 21 ]. Lastly, Takx et al demonstrated that total cholesterol, triglycerides, and HbA1c are associated with NaF uptake in the femoral arteries of DM2 patients [ 15 ].…”

“…Ryoo reported that in patients with suspected CAD, the burden of NaF uptake in the descending thoracic aorta was significantly associated with diabetes mellitus and serum HbA1c level, while the overall burden of CT calcium deposition correlated significantly with hypertension, metabolic syndrome, and 10-year CVD risk score [ 21 ]. Takx et al demonstrated that higher CT calcium, total cholesterol, and HbA1c were associated with higher NaF TBR in the femoral arteries of DM2 patients [ 15 ].…”

“…Thus, the study reporting surprisingly low coronary arterial NaF uptake in D1M or D2M patients [ 3 ] could not discriminate properly between categories and their respective treatments, nor could it explain the low NaF uptake in relation to previous studies demonstrating increased CT-detectable calcification in diabetic patients. Similarly, the study showing that the burden of NaF uptake in the descending thoracic aorta was significantly correlated with diabetes mellitus and serum HbA1c level, whereas the overall burden of CT calcium deposition was significantly correlated with hypertension, metabolic syndrome and 10-year CVD risk score, was not designed to further account for the shown statistical difference [ 21 ].…”