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Majeed K, Bellinge JW, Butcher SC, Alcock R, Spiro J, Playford D, Hillis GS, Newby DE, Mori TA, Francis R, Schultz CJ. Coronary 18F-sodium fluoride PET detects high-risk plaque features on optical coherence tomography and CT-angiography in patients with acute coronary syndrome. Atherosclerosis 2020; 319:142-148. [PMID: 33358367 DOI: 10.1016/j.atherosclerosis.2020.12.010] [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: 06/28/2020] [Revised: 11/08/2020] [Accepted: 12/11/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS 18F-Sodium Fluoride Positron Emission Tomography (18F-NaF PET) non-invasively detects micro-calcification activity, the earliest stage of atherosclerotic arterial calcification. We studied the association between coronary 18F-NaF uptake and high-risk plaque features on intra-coronary optical coherence tomography (OCT) and CT-angiography (CTCA) and the potential application to patient-level risk stratification. METHODS Sixty-two prospectively recruited patients with acute coronary syndrome (ACS) underwent multi-vessel OCT, 18F-NaF PET and CTCA. The maximum tissue to background ratio (TBRmax = standardised uptake value (SUV)max/SUVbloodpool) was measured in each coronary segment on 18F-NaF PET scans. High-risk plaque features on OCT and CTCA were compared in matched coronary segments. The number of patients testing positive (>2SD above the normal range) for micro-calcification activity was determined. RESULTS In 62 patients (age, mean ± standard deviation (SD) = 61 ± 9 years, 85% male) the coronary segments with elevated 18F-NaF uptake had higher lipid arc (LA) (median [25th-75th centile]: 74° [35°-117°] versus 48° [15°-83°], p=0.021), higher prevalence of macrophages [n(%): 37 (62%) versus 89 (39%), p=0.008] and lower plaque free wall (PFW) (50° [7°-110°] versus 94° [34°-180°], p=0.027) on OCT, and a higher total plaque burden (p=0.011) and higher dense calcified plaque burden (p= 0.001) on CTCA, when compared with 18F-NaF negative segments. Patients grouped by increasing number of coronary lesions positive for microcalcification activity (0,1, ≥2) showed decreasing plaque free wall, increasing calcification and increasing macrophages on OCT (respectively p=0.008, p < 0.001 and p=0.028). CONCLUSIONS 18F-NaF uptake is associated with high-risk plaque features on OCT and CTCA in a per-segment and per-patient analysis in subjects hospitalized for ACS.
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Affiliation(s)
- Kamran Majeed
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Jamie W Bellinge
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Steele C Butcher
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Richard Alcock
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jon Spiro
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - David Playford
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Graham S Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - David E Newby
- Centre for Cardiovascular Science, Clinical Research Imaging Centre, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Trevor A Mori
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Roslyn Francis
- Medical School, University of Western Australia, Perth, Western Australia, Australia; Nuclear Medicine Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Carl J Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia.
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Affiliation(s)
- Kamran Majeed
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Graham S Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Carl J Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia.
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Ueki Y, Räber L, Otsuka T, Rai H, Losdat S, Windecker S, Garcia-Garcia HM, Landmesser U, Koolen J, Byrne R, Haude M, Joner M. Mechanism of Drug-Eluting Absorbable Metal Scaffold Restenosis. Circ Cardiovasc Interv 2020; 13:e008657. [DOI: 10.1161/circinterventions.119.008657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The pathomechanisms underlying restenosis of the bioabsorbable sirolimus-eluting metallic scaffold (Magmaris) remain unknown. Using serial optical coherence tomography, we investigated causes of restenosis, including the contribution of late scaffold recoil versus neointimal hyperplasia.
Methods:
Patients enrolled in BIOSOLVE-II undergoing serial angiography and optical coherence tomography (post-intervention and follow-up: 6 months and/or 1 year) were analyzed. Patients were divided into 2 groups according to angiographic in-scaffold late lumen loss (LLL) <0.5 or ≥0.5 mm. End points were late absolute scaffold recoil and neointimal hyperplasia area as assessed by optical coherence tomography.
Results:
Serial data were available for analysis from 70 patients (LLL <0.5 mm: n=41; LLL ≥0.5 mm: n=29). Patient and lesion characteristics were comparable, and there was no significant difference in mean and minimal scaffold area between groups at post-intervention. Late absolute scaffold recoil was less among patients with LLL <0.5 mm (0.53±0.68 mm
2
) compared with those with LLL ≥0.5 mm (1.48±1.20 mm
2
;
P
<0.001). Neointimal hyperplasia area was smaller among patients with LLL <0.5 mm at follow-up (1.47±0.33 mm
2
) compared with patients with LLL ≥0.5 mm (1.68±0.34 mm
2
;
P
=0.013). In a matched-frame analysis (post-intervention and follow-up), late absolute scaffold recoil varied according to the underlying plaque type (lipid: 0.63±1.23 mm
2
; calcified: 0.81±1.44 mm
2
; and fibrous: 1.20±1.52 mm
2
;
P
<0.001), while there was no difference with regards to neointimal hyperplasia area (
P
=0.132).
Conclusions:
In addition to neointimal hyperplasia, late scaffold recoil contributed significantly to LLL of sirolimus-eluting absorbable metal scaffolds. The extent of late scaffold recoil was dependent on the underlying plaque morphology and was the highest among fibrotic lesions.
Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01960504.
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Affiliation(s)
- Yasushi Ueki
- Department of Cardiology, Bern University Hospital, Switzerland (Y.U., L.R., T.O., S.W.)
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Switzerland (Y.U., L.R., T.O., S.W.)
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, Switzerland (Y.U., L.R., T.O., S.W.)
| | - Himanshu Rai
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.R., R.B., M.J.)
| | - Sylvain Losdat
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Switzerland (S.L.)
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Switzerland (Y.U., L.R., T.O., S.W.)
| | | | - Ulf Landmesser
- Department of Cardiology, Charite Universitätsmedizin Berlin, Germany (U.L.)
| | - Jacques Koolen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (J.K.)
| | - Robert Byrne
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.R., R.B., M.J.)
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Germany (M.H.)
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.R., R.B., M.J.)
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