Predictors of 18F-sodium fluoride uptake in patients with stable coronary artery disease and adverse plaque features on computed tomography angiography. (18th June 2019)

• Record Type: Journal Article
• Authors: Kwiecinski, Jacek; Dey, Damini; Cadet, Sebastien; Lee, Sang-Eun; Tamarappoo, Balaji; Otaki, Yuka; Huynh, Phi T; Friedman, John D; Dweck, Mark R; Newby, David E; Yun, Mijin; Chang, Hyuk-Jae; Slomka, Piotr J; Berman, Daniel S
• Is Part Of: European heart journal. Volume 21:Number 1(2020)
• Page Start: 58
• Page End: 66
• Publication Date: 2019-06-18
• Subjects: PET/CT -- coronary computed tomography angiography -- coronary imaging -- adverse plaque features -- 18F-sodium fluoride -- low attenuation plaque; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jez152
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims: In patients with stable coronary artery disease (CAD) and high-risk plaques (HRPs) on coronary computed tomography angiography (CTA), we sought to define qualitative and quantitative CTA predictors of abnormal coronary 18 F-sodium fluoride uptake ( 18 F-NaF) by positron emission tomography (PET). Methods and results: Patients undergoing coronary CTA were screened for HRP. Those who presented with ≥3 CTA adverse plaque features (APFs) including positive remodelling; low attenuation plaque (LAP, <30 HU), spotty calcification; obstructive coronary stenosis ≥50%; plaque volume >100 mm 3 were recruited for 18 F-NaF PET. In lesions with stenosis ≥25%, quantitative plaque analysis and maximum 18 F-NaF target to background ratios (TBRs) were measured. Of 55 patients, 35 (64%) manifested coronary 18 F-NaF uptake. Of 68 high-risk lesions 49 (70%) had increased PET tracer activity. Of the APFs, LAP had the highest sensitivity (39.4%) and specificity (98.3%) for predicting 18 F-NaF uptake. TBR values were higher in lesions with LAP compared to those without [1.6 (1.3–1.8) vs. 1.1 (1.0–1.3), P = 0.01]. On adjusted multivariable regression analysis, LAP (both qualitative and quantitative) was independently associated with plaque TBR [LAP qualitative: β = 0.47, 95% confidence interval (CI) 0.30–0.65; P < 0.001] and (LAP volume: β = 0.20 per 10 mm 3, 95% CI 0.13–0.27; P < 0.001). Conclusion: In stable CAD patients with HRP, LAP is predictive of 18 F-NaF coronary uptake, but 18 F-NaF is often seen in the absence of LAP. If 18 F-NaF uptake is shown to be associated with adverse outcomes and becomes clinically used, the presence of LAP may define patients who would not benefit from the added testing.