Predictors of 18F-sodiumfluoride uptake in patients with stable coronary artery disease and adverse plaque features on computed tomography angiography
Predictors of 18F-sodiumfluoride uptake in patients with stable coronary artery disease and adverse plaque features on computed tomography angiography
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DOI：
10.1093/ehjci/jez152
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发表时间：
2020-01-01
影响因子：
6.2
通讯作者：
Berman, Daniel S.
中科院分区：
文献类型：
--
作者：
Kwiecinski, Jacek;Dey, Damini;Berman, Daniel S.
目的在冠状动脉计算机断层扫描血管造影（CTA）显示稳定性冠状动脉疾病（CAD）和高危斑块（HRP）的患者中，我们试图通过正电子发射断层扫描（PET）确定冠状动脉F-18-NaF摄取异常（F-18-NaF）的定性和定量CTA预测因子。招募具有≥ 3个CTA不良斑块特征（APF）的患者进行F-18-NaF PET，包括阳性重塑;低衰减斑块（≥ 50%）;斑块体积>100 mm 3。在狭窄>= 25%的病变中，测量定量斑块分析和最大F-18-NaF目标与背景比值（TBRs）。在55例患者中，35例（64%）表现出冠状动脉F-18-NaF摄取。在68个高危病变中，49个（70%）PET示踪剂活性增加。在APF中，APF预测F-18-NaF摄取的敏感性（39.4%）和特异性（98.3%）最高。与未发生病变的病变相比，发生病变的TBR值更高[1.6（1.3-1.8）vs. 1.1（1.0-1.3），P= 0.01]。在调整的多变量回归分析中，（定性和定量）与斑块TBR独立相关[斑块定性：β = 0.47，95%置信区间（CI）0.30-0.65; P< 0.001]，结论在稳定期冠心病患者中，HRP阳性率可预测F-18-NaF的摄取，但F-18-NaF多见于无HRP阳性的冠心病患者。如果F-18-NaF摄取被证明与不良结局相关并被临床使用，则可能会定义无法从增加的测试中获益的患者。
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 F-18-sodium fluoride uptake (F-18-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, = 50%; plaque volume >100 mm3 were recruited for F-18-NaF PET. In lesions with stenosis >= 25%, quantitative plaque analysis and maximum F-18-NaF target to background ratios (TBRs) were measured. Of 55 patients, 35 (64%) manifested coronary F-18-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 F-18-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: beta = 0.47, 95% confidence interval (CI) 0.30-0.65; P< 0.001] and (LAP volume: beta = 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 F-18-NaF coronary uptake, but F-18-NaF is often seen in the absence of LAP. If F-18-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.