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Tzolos E, Dweck MR. 18F-Sodium Fluoride ( 18F-NaF) for Imaging Microcalcification Activity in the Cardiovascular System. Arterioscler Thromb Vasc Biol 2020; 40:1620-1626. [PMID: 32375543 PMCID: PMC7310305 DOI: 10.1161/atvbaha.120.313785] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/15/2020] [Indexed: 01/23/2023]
Abstract
Accumulating preclinical and clinical evidence suggests that calcification is one of the body's primary responses to injury and a key pathological feature of cardiovascular disease. Calcification activity can now be imaged using 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) in combination with either computed tomography or magnetic resonance. These techniques allow visualization of calcification activity and, therefore, provide different information to the established macroscopic calcium imaged with computed tomography. Indeed, 18F-NaF PET has been used to investigate a wide range of valvular conditions, including aortic stenosis, mitral annular calcification, and bioprosthetic valve disease, as well as vascular conditions, including abdominal aortic aneurysm disease, coronary, and carotid atherosclerosis, peripheral vascular disease, and erectile dysfunction. In this brief review, we will focus on how 18F-NaF PET has improved our pathophysiological understanding of cardiovascular calcification and how it can be used as a marker of vascular calcification, providing a useful tool that can be utilized in clinical trials investigating the prediction of both disease progression and clinical events. Finally, we will discuss how 18F-NaF might be employed clinically to improve patient assessment and to guide decision-making.
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Affiliation(s)
- Evangelos Tzolos
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
| | - Marc R. Dweck
- From the BHF Centre for Cardiovascular Science, University of Edinburgh, United Kingdom
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Sengupta SP, Mohan JC. Calcific Mitral Stenosis: Echoes of Aging. J Am Coll Cardiol 2020; 75:3058-3060. [PMID: 32553259 DOI: 10.1016/j.jacc.2020.04.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
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Heffron SP, Dwivedi A, Rockman CB, Xia Y, Guo Y, Zhong J, Berger JS. Body mass index and peripheral artery disease. Atherosclerosis 2020; 292:31-36. [PMID: 31739257 PMCID: PMC6981229 DOI: 10.1016/j.atherosclerosis.2019.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/08/2019] [Accepted: 10/25/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS An independent association of body mass index (BMI) with atherosclerotic cardiovascular disease is somewhat controversial and may differ by vascular bed. Sex-specific risk factors for atherosclerosis may further modify these associations. Obesity and peripheral artery disease (PAD) are both more prevalent in women. We sought to determine the association between PAD and BMI using a very large population-based study. METHODS Self-referred individuals at >20,000 US sites completed medical questionnaires including height and weight, and were evaluated by screening ankle brachial indices (ABI) for PAD (ABI<0.9). RESULTS Among 3,250,350 individuals, the mean age was 63.1 ± 10.5 years and 65.5% were women. The mean BMI was 27.7 ± 5.8 kg/m2. 27.8% of participants were obese (BMI ≥30 kg/m2) - 27.6% females, 28.1% males. Overweight individuals (BMI 25-29.9 kg/m2) exhibited the lowest prevalence of PAD. There was a J-shaped association of BMI with prevalent PAD. After adjustment for age and cardiovascular risk factors, underweight was associated with similarly increased odds of PAD (1.72 vs. 1.39, women and men, respectively). The association of obesity with PAD was predominant in women, with only a slight association of increasing BMI with PAD in men (OR = 2.98 vs. 1.37 for BMI ≥40 kg/m2). CONCLUSIONS Our study suggests that increasing BMI is a robust independent risk factor for PAD only in women. This observation requires validation, but highlights the need for further research on sex-specific risk and mechanisms of atherosclerosis.
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Affiliation(s)
- Sean P Heffron
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, NY, USA; Center for the Prevention of Cardiovascular Disease, New York University Langone Medical Center, New York, NY, USA
| | - Aeshita Dwivedi
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Caron B Rockman
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Yuhe Xia
- Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, NY, USA
| | - Yu Guo
- Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, NY, USA
| | - Judy Zhong
- Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, NY, USA
| | - Jeffrey S Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, NY, USA; Center for the Prevention of Cardiovascular Disease, New York University Langone Medical Center, New York, NY, USA; Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, USA.
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de Waard D, Alukayli M, Gelinas J, Iglesias I, Fujii S, Bagur R, Chu MWA. Minimally Invasive Hybrid Approach to High Risk Mitral Disease With Severe Mitral Annular Calcification. Can J Cardiol 2019; 36:966.e11-966.e13. [PMID: 32414620 DOI: 10.1016/j.cjca.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/01/2019] [Accepted: 12/06/2019] [Indexed: 11/19/2022] Open
Abstract
Severe circumferential mitral annular calcification (MAC) remains a significant challenge, complicating surgical treatment of mitral valve disease. Transcatheter treatment options are attractive; however, they remain fraught with risks of annular fixation, paravalvular leak, atrioventricular-groove disruption, and left-ventricular outflow tract obstruction. We describe a novel minimally invasive hybrid technique of transcatheter mitral valve replacement in a patient with severe circumferential MAC.
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Affiliation(s)
- Dominique de Waard
- Division of Cardiac Surgery, Western University, London, Ontario, Canada; Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mahmoud Alukayli
- Division of Cardiac Surgery, Western University, London, Ontario, Canada; Division of Cardiac Surgery, King Faisal Cardiac Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Jill Gelinas
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Ivan Iglesias
- Department of Anaesthesiology, Western University, London, Ontario, Canada
| | - Satoru Fujii
- Department of Anaesthesiology, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- Division of Cardiology, Western University, London, Ontario, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Western University, London, Ontario, Canada.
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Usuku H, Yamamoto E, Arima Y, Takashio S, Araki S, Sueta D, Kanazawa H, Suzuki S, Yoshimura H, Tsunoda R, Nishigami K, Uekihara S, Sakamoto K, Kawano H, Kaikita K, Matsui H, Tsujita K. Accumulation of coronary risk factors is associated with progression of mitral annular calcification in patients undergoing dialysis therapy: A long-term follow-up study. Int J Cardiol 2019; 293:248-253. [DOI: 10.1016/j.ijcard.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/18/2019] [Accepted: 05/02/2019] [Indexed: 11/15/2022]
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Chronic kidney disease and valvular heart disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2019; 96:836-849. [DOI: 10.1016/j.kint.2019.06.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 11/21/2022]
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Raggi P, Prandini N, Ligabue G, Braglia G, Esposito F, Milic J, Malagoli A, Scaglioni R, Besutti G, Beghetto B, Nardini G, Roncaglia E, Mussini C, Guaraldi G. Molecular Imaging of Vascular Calcification with 18F-Sodium-Fluoride in Patients Infected with Human Immunodeficiency Virus. Int J Mol Sci 2019; 20:ijms20051183. [PMID: 30857165 PMCID: PMC6429185 DOI: 10.3390/ijms20051183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022] Open
Abstract
18F-Sodium Fluoride (NaF) accumulates in areas of active hydroxyapatite deposition and potentially unstable atherosclerotic plaques. We assessed the presence of atherosclerotic plaques in 50 adult patients with HIV (HIV+) who had undergone two cardiac computed tomography scans to measure coronary artery calcium (CAC) progression. CAC and its progression are predictive of an unfavorable prognosis. Tracer uptake was quantified in six arterial territories: aortic arch, innominate carotid artery, right and left internal carotid arteries, left coronary (anterior descending and circumflex) and right coronary artery. Thirty-one patients showed CAC progression and 19 did not. At least one territory with high NaF uptake was observed in 150 (50%) of 300 arterial territories. High NaF uptake was detected more often in non-calcified than calcified areas (68% vs. 32%), and in patients without than in those with prior CAC progression (68% vs. 32%). There was no correlation between clinical and demographic variables and NaF uptake. In clinically stable HIV+ patients, half of the arterial territories showed a high NaF uptake, often in the absence of macroscopic calcification. NaF uptake at one time point did not correlate with prior progression of CAC. Prospective studies will demonstrate the prognostic significance of high NaF uptake in HIV+ patients.
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Affiliation(s)
- Paolo Raggi
- Division of Cardiology and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, 11220 83rd Avenue, Suite 5A9-014, Edmonton, AB T6G 2B7, Canada.
| | - Napoleone Prandini
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Guido Ligabue
- Department of Radiology, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Giovanni Braglia
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Francesco Esposito
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Jovana Milic
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Andrea Malagoli
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Riccardo Scaglioni
- Department of Radiology, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Giulia Besutti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Barbara Beghetto
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Giulia Nardini
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Enrica Roncaglia
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Cristina Mussini
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
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