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Thoracic Aortic (18)F-Sodium Fluoride Activity and Ischemic Stroke in Patients With Established Cardiovascular Disease

BACKGROUND: Aortic atherosclerosis represents an important contributor to ischemic stroke risk. Identifying patients with high-risk aortic atheroma could improve preventative treatment strategies for future ischemic stroke. OBJECTIVES: The purpose of this study was to investigate whether thoracic (1...

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Autores principales: Fletcher, Alexander J., Tew, Yong Y., Tzolos, Evangelos, Joshi, Shruti S., Kaczynski, Jakub, Nash, Jennifer, Debono, Samuel, Lembo, Maria, Kwiecinski, Jacek, Bing, Rong, Syed, Maaz B.J., Doris, Mhairi K., van Beek, Edwin J.R., Moss, Alistair J., Jenkins, William S., Walker, Niki L., Joshi, Nikhil V., Pawade, Tania A., Adamson, Philip D., Whiteley, William N., Wardlaw, Joanna M., Slomka, Piotr J., Williams, Michelle C., Newby, David E., Dweck, Marc R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9252920/
https://www.ncbi.nlm.nih.gov/pubmed/35183477
http://dx.doi.org/10.1016/j.jcmg.2021.12.013
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author Fletcher, Alexander J.
Tew, Yong Y.
Tzolos, Evangelos
Joshi, Shruti S.
Kaczynski, Jakub
Nash, Jennifer
Debono, Samuel
Lembo, Maria
Kwiecinski, Jacek
Bing, Rong
Syed, Maaz B.J.
Doris, Mhairi K.
van Beek, Edwin J.R.
Moss, Alistair J.
Jenkins, William S.
Walker, Niki L.
Joshi, Nikhil V.
Pawade, Tania A.
Adamson, Philip D.
Whiteley, William N.
Wardlaw, Joanna M.
Slomka, Piotr J.
Williams, Michelle C.
Newby, David E.
Dweck, Marc R.
author_facet Fletcher, Alexander J.
Tew, Yong Y.
Tzolos, Evangelos
Joshi, Shruti S.
Kaczynski, Jakub
Nash, Jennifer
Debono, Samuel
Lembo, Maria
Kwiecinski, Jacek
Bing, Rong
Syed, Maaz B.J.
Doris, Mhairi K.
van Beek, Edwin J.R.
Moss, Alistair J.
Jenkins, William S.
Walker, Niki L.
Joshi, Nikhil V.
Pawade, Tania A.
Adamson, Philip D.
Whiteley, William N.
Wardlaw, Joanna M.
Slomka, Piotr J.
Williams, Michelle C.
Newby, David E.
Dweck, Marc R.
author_sort Fletcher, Alexander J.
collection PubMed
description BACKGROUND: Aortic atherosclerosis represents an important contributor to ischemic stroke risk. Identifying patients with high-risk aortic atheroma could improve preventative treatment strategies for future ischemic stroke. OBJECTIVES: The purpose of this study was to investigate whether thoracic (18)F-sodium fluoride positron emission tomography (PET) could improve the identification of patients at the highest risk of ischemic stroke. METHODS: In a post hoc observational cohort study, we quantified thoracic aortic and coronary (18)F-sodium fluoride activity in 461 patients with stable cardiovascular disease undergoing PET combined with computed tomography (CT). Progression of atherosclerosis was assessed by change in aortic and coronary CT calcium volume. Clinical outcomes were determined by the occurrence of ischemic stroke and myocardial infarction. We compared the prognostic utility of (18)F-sodium fluoride activity for predicting stroke to clinical risk scores and CT calcium quantification using survival analysis and multivariable Cox regression. RESULTS: After 12.7 ± 2.7 months, progression of thoracic aortic calcium volume correlated with baseline thoracic aortic (18)F-sodium fluoride activity (n = 140; r = 0.31; P = 0.00016). In 461 patients, 23 (5%) patients experienced an ischemic stroke and 32 (7%) a myocardial infarction after 6.1 ± 2.3 years of follow-up. High thoracic aortic (18)F-sodium fluoride activity was strongly associated with ischemic stroke (HR: 10.3 [95% CI: 3.1-34.8]; P = 0.00017), but not myocardial infarction (P = 0.40). Conversely, high coronary (18)F-sodium fluoride activity was associated with myocardial infarction (HR: 4.8 [95% CI: 1.9-12.2]; P = 0.00095) but not ischemic stroke (P = 0.39). In a multivariable Cox regression model including imaging and clinical risk factors, thoracic aortic (18)F-sodium fluoride activity was the only variable associated with ischemic stroke (HR: 8.19 [95% CI: 2.33-28.7], P = 0.0010). CONCLUSIONS: In patients with established cardiovascular disease, thoracic aortic (18)F-sodium fluoride activity is associated with the progression of atherosclerosis and future ischemic stroke. Arterial (18)F-sodium fluoride activity identifies localized areas of atherosclerotic disease activity that are directly linked to disease progression and downstream regional clinical atherothrombotic events. (DIAMOND–Dual Antiplatelet Therapy to Reduce Myocardial Injury [DIAMOND], NCT02110303; Study Investigating the Effect of Drugs Used to Treat Osteoporosis on the Progression of Calcific Aortic Stenosis [SALTIRE II], NCT02132026; Novel Imaging Approaches To Identify Unstable Coronary Plaques, NCT01749254; and Role of Active Valvular Calcification and Inflammation in Patients With Aortic Stenosis, NCT01358513)
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spelling pubmed-92529202022-07-06 Thoracic Aortic (18)F-Sodium Fluoride Activity and Ischemic Stroke in Patients With Established Cardiovascular Disease Fletcher, Alexander J. Tew, Yong Y. Tzolos, Evangelos Joshi, Shruti S. Kaczynski, Jakub Nash, Jennifer Debono, Samuel Lembo, Maria Kwiecinski, Jacek Bing, Rong Syed, Maaz B.J. Doris, Mhairi K. van Beek, Edwin J.R. Moss, Alistair J. Jenkins, William S. Walker, Niki L. Joshi, Nikhil V. Pawade, Tania A. Adamson, Philip D. Whiteley, William N. Wardlaw, Joanna M. Slomka, Piotr J. Williams, Michelle C. Newby, David E. Dweck, Marc R. JACC Cardiovasc Imaging Original Research BACKGROUND: Aortic atherosclerosis represents an important contributor to ischemic stroke risk. Identifying patients with high-risk aortic atheroma could improve preventative treatment strategies for future ischemic stroke. OBJECTIVES: The purpose of this study was to investigate whether thoracic (18)F-sodium fluoride positron emission tomography (PET) could improve the identification of patients at the highest risk of ischemic stroke. METHODS: In a post hoc observational cohort study, we quantified thoracic aortic and coronary (18)F-sodium fluoride activity in 461 patients with stable cardiovascular disease undergoing PET combined with computed tomography (CT). Progression of atherosclerosis was assessed by change in aortic and coronary CT calcium volume. Clinical outcomes were determined by the occurrence of ischemic stroke and myocardial infarction. We compared the prognostic utility of (18)F-sodium fluoride activity for predicting stroke to clinical risk scores and CT calcium quantification using survival analysis and multivariable Cox regression. RESULTS: After 12.7 ± 2.7 months, progression of thoracic aortic calcium volume correlated with baseline thoracic aortic (18)F-sodium fluoride activity (n = 140; r = 0.31; P = 0.00016). In 461 patients, 23 (5%) patients experienced an ischemic stroke and 32 (7%) a myocardial infarction after 6.1 ± 2.3 years of follow-up. High thoracic aortic (18)F-sodium fluoride activity was strongly associated with ischemic stroke (HR: 10.3 [95% CI: 3.1-34.8]; P = 0.00017), but not myocardial infarction (P = 0.40). Conversely, high coronary (18)F-sodium fluoride activity was associated with myocardial infarction (HR: 4.8 [95% CI: 1.9-12.2]; P = 0.00095) but not ischemic stroke (P = 0.39). In a multivariable Cox regression model including imaging and clinical risk factors, thoracic aortic (18)F-sodium fluoride activity was the only variable associated with ischemic stroke (HR: 8.19 [95% CI: 2.33-28.7], P = 0.0010). CONCLUSIONS: In patients with established cardiovascular disease, thoracic aortic (18)F-sodium fluoride activity is associated with the progression of atherosclerosis and future ischemic stroke. Arterial (18)F-sodium fluoride activity identifies localized areas of atherosclerotic disease activity that are directly linked to disease progression and downstream regional clinical atherothrombotic events. (DIAMOND–Dual Antiplatelet Therapy to Reduce Myocardial Injury [DIAMOND], NCT02110303; Study Investigating the Effect of Drugs Used to Treat Osteoporosis on the Progression of Calcific Aortic Stenosis [SALTIRE II], NCT02132026; Novel Imaging Approaches To Identify Unstable Coronary Plaques, NCT01749254; and Role of Active Valvular Calcification and Inflammation in Patients With Aortic Stenosis, NCT01358513) Elsevier 2022-07 /pmc/articles/PMC9252920/ /pubmed/35183477 http://dx.doi.org/10.1016/j.jcmg.2021.12.013 Text en © 2022 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Original Research
Fletcher, Alexander J.
Tew, Yong Y.
Tzolos, Evangelos
Joshi, Shruti S.
Kaczynski, Jakub
Nash, Jennifer
Debono, Samuel
Lembo, Maria
Kwiecinski, Jacek
Bing, Rong
Syed, Maaz B.J.
Doris, Mhairi K.
van Beek, Edwin J.R.
Moss, Alistair J.
Jenkins, William S.
Walker, Niki L.
Joshi, Nikhil V.
Pawade, Tania A.
Adamson, Philip D.
Whiteley, William N.
Wardlaw, Joanna M.
Slomka, Piotr J.
Williams, Michelle C.
Newby, David E.
Dweck, Marc R.
Thoracic Aortic (18)F-Sodium Fluoride Activity and Ischemic Stroke in Patients With Established Cardiovascular Disease
title Thoracic Aortic (18)F-Sodium Fluoride Activity and Ischemic Stroke in Patients With Established Cardiovascular Disease
title_full Thoracic Aortic (18)F-Sodium Fluoride Activity and Ischemic Stroke in Patients With Established Cardiovascular Disease
title_fullStr Thoracic Aortic (18)F-Sodium Fluoride Activity and Ischemic Stroke in Patients With Established Cardiovascular Disease
title_full_unstemmed Thoracic Aortic (18)F-Sodium Fluoride Activity and Ischemic Stroke in Patients With Established Cardiovascular Disease
title_short Thoracic Aortic (18)F-Sodium Fluoride Activity and Ischemic Stroke in Patients With Established Cardiovascular Disease
title_sort thoracic aortic (18)f-sodium fluoride activity and ischemic stroke in patients with established cardiovascular disease
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9252920/
https://www.ncbi.nlm.nih.gov/pubmed/35183477
http://dx.doi.org/10.1016/j.jcmg.2021.12.013
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