Peri-Coronary Adipose Tissue Density Is Associated With 18F-Sodium Fluoride Coronary Uptake in Stable Patients With High-Risk Plaques

Jacek Kwiecinski, Damini Dey, Sebastien Cadet, Sang Eun Lee, Yuka Otaki, Phi T. Huynh, Mhairi K. Doris, Evann Eisenberg, Mijin Yun, Maurits A. Jansen, Michelle C. Williams, Balaji K. Tamarappoo, John D. Friedman, Marc R. Dweck, David E. Newby, Hyuk Jae Chang, Piotr J. Slomka, Daniel S. Berman

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)2000-2010
Number of pages11
JournalJACC: Cardiovascular Imaging
Volume12
Issue number10
DOIs
Publication statusPublished - 2019 Oct

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Sodium Fluoride
Adipose Tissue
Positron-Emission Tomography
Confidence Intervals
Atherosclerotic Plaques
Blood Vessels
Pathologic Constriction
Biomarkers
Regression Analysis
Computed Tomography Angiography
Inflammation

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Kwiecinski, Jacek ; Dey, Damini ; Cadet, Sebastien ; Lee, Sang Eun ; Otaki, Yuka ; Huynh, Phi T. ; Doris, Mhairi K. ; Eisenberg, Evann ; Yun, Mijin ; Jansen, Maurits A. ; Williams, Michelle C. ; Tamarappoo, Balaji K. ; Friedman, John D. ; Dweck, Marc R. ; Newby, David E. ; Chang, Hyuk Jae ; Slomka, Piotr J. ; Berman, Daniel S. / Peri-Coronary Adipose Tissue Density Is Associated With 18F-Sodium Fluoride Coronary Uptake in Stable Patients With High-Risk Plaques. In: JACC: Cardiovascular Imaging. 2019 ; Vol. 12, No. 10. pp. 2000-2010.
@article{f3f50b3bd0644f94977b41fe684297a9,
title = "Peri-Coronary Adipose Tissue Density Is Associated With 18F-Sodium Fluoride Coronary Uptake in Stable Patients With High-Risk Plaques",
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.",
author = "Jacek Kwiecinski and Damini Dey and Sebastien Cadet and Lee, {Sang Eun} and Yuka Otaki and Huynh, {Phi T.} and Doris, {Mhairi K.} and Evann Eisenberg and Mijin Yun and Jansen, {Maurits A.} and Williams, {Michelle C.} and Tamarappoo, {Balaji K.} and Friedman, {John D.} and Dweck, {Marc R.} and Newby, {David E.} and Chang, {Hyuk Jae} and Slomka, {Piotr J.} and Berman, {Daniel S.}",
year = "2019",
month = "10",
doi = "10.1016/j.jcmg.2018.11.032",
language = "English",
volume = "12",
pages = "2000--2010",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",
number = "10",

}

Kwiecinski, J, Dey, D, Cadet, S, Lee, SE, Otaki, Y, Huynh, PT, Doris, MK, Eisenberg, E, Yun, M, Jansen, MA, Williams, MC, Tamarappoo, BK, Friedman, JD, Dweck, MR, Newby, DE, Chang, HJ, Slomka, PJ & Berman, DS 2019, '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, pp. 2000-2010. https://doi.org/10.1016/j.jcmg.2018.11.032

Peri-Coronary Adipose Tissue Density Is Associated With 18F-Sodium Fluoride Coronary Uptake in Stable Patients With High-Risk Plaques. / Kwiecinski, Jacek; Dey, Damini; Cadet, Sebastien; Lee, Sang Eun; Otaki, Yuka; Huynh, Phi T.; Doris, Mhairi K.; Eisenberg, Evann; Yun, Mijin; Jansen, Maurits A.; Williams, Michelle C.; Tamarappoo, Balaji K.; Friedman, John D.; Dweck, Marc R.; Newby, David E.; Chang, Hyuk Jae; Slomka, Piotr J.; Berman, Daniel S.

In: JACC: Cardiovascular Imaging, Vol. 12, No. 10, 10.2019, p. 2000-2010.

Research output: Contribution to journalArticle

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.

PY - 2019/10

Y1 - 2019/10

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.

AB - 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.

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DO - 10.1016/j.jcmg.2018.11.032

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