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Oliveira-Santos M, Borges-Rosa J, Silva R, Paixão L, Santo CE, Abrunhosa A, Castelo-Branco M, Slomka PJ, Gonçalves L, Ferreira MJ. Rosuvastatin effect on atherosclerotic plaque metabolism: A subclinical atherosclerosis imaging study with 18F-NaF PET-CT. Atherosclerosis 2024; 395:117481. [PMID: 38480058 DOI: 10.1016/j.atherosclerosis.2024.117481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND AND AIMS Atherosclerotic plaque fluorine-18 sodium fluoride (18F-NaF) uptake on positron emission tomography with computed tomography (PET-CT) identifies active microcalcification and has been shown to correlate with clinical instability in patients with cardiovascular (CV) disease. Statin therapy promotes coronary macrocalcification over time. Our aim was to investigate rosuvastatin effect on atheroma 18F-NaF uptake. METHODS Subjects with high CV risk but without CV events underwent 18F-NaF-PET-CT in a single-centre. Those with subclinical atherosclerosis and significant 18F-NaF plaque uptake were included in a single-arm clinical trial, treated with rosuvastatin 20 mg/daily for six months, and re-evaluated by 18F-NaF-PET-CT. Primary endpoint was reduction in maximum atheroma 18F-NaF uptake in the coronary, aortic or carotid arteries, assessed by the tissue-to-background ratio (TBR). The secondary endpoint was corrected uptake per lesion (CUL) variation. RESULTS Forty individuals were enrolled and 38 included in the pharmacological trial; mean age was 64 years, two-thirds were male and most were diabetic. The 10-year expected CV risk was 9.5% (6.0-15.3) for SCORE2 and 31.7 ± 18.7% for ASCVD systems. After six months of rosuvastatin treatment (n = 34), low-density lipoprotein cholesterol lowered from 133.6 ± 33.8 to 58.8 ± 20.7 mg dL-1 (60% relative reduction, p < 0.01). There was a significant 19% reduction in maximum plaque 18F-NaF uptake after treatment, from 1.96 (1.78-2.22) to 1.53 (1.40-2.10), p < 0.001 (primary endpoint analysis). The secondary endpoint CUL was reduced by 23% (p = 0.003). CONCLUSION In a single-centre non-randomized clinical trial of high CV risk individuals with subclinical atherosclerosis, the maximum atherosclerotic plaque 18F-NaF uptake was significantly reduced after six months of high-intensity statin.
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Affiliation(s)
- Manuel Oliveira-Santos
- Cardiology Department, Unidade Local de Saúde de Coimbra, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal; Institute of Nuclear Sciences Applied to Health - University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal.
| | - João Borges-Rosa
- Cardiology Department, Unidade Local de Saúde de Coimbra, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
| | - Rodolfo Silva
- Institute of Nuclear Sciences Applied to Health - University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Luís Paixão
- Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
| | | | - Antero Abrunhosa
- Institute of Nuclear Sciences Applied to Health - University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Miguel Castelo-Branco
- Institute of Nuclear Sciences Applied to Health - University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Piotr J Slomka
- Division of Artificil Inteligence in Medicine, Department of Medicine, Cedars-Sinai, Los Angeles, USA
| | - Lino Gonçalves
- Cardiology Department, Unidade Local de Saúde de Coimbra, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Maria João Ferreira
- Cardiology Department, Unidade Local de Saúde de Coimbra, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal; Institute of Nuclear Sciences Applied to Health - University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal; Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
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NaF-PET Imaging of Atherosclerosis Burden. J Imaging 2023; 9:jimaging9020031. [PMID: 36826950 PMCID: PMC9966512 DOI: 10.3390/jimaging9020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The method of 18F-sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) of atherosclerosis was introduced 12 years ago. This approach is particularly interesting because it demonstrates microcalcification as an incipient sign of atherosclerosis before the development of arterial wall macrocalcification detectable by CT. However, this method has not yet found its place in the clinical routine. The more exact association between NaF uptake and future arterial calcification is not fully understood, and it remains unclear to what extent NaF-PET may replace or significantly improve clinical cardiovascular risk scoring. The first 10 years of publications in the field were characterized by heterogeneity at multiple levels, and it is not clear how the method may contribute to triage and management of patients with atherosclerosis, including monitoring effects of anti-atherosclerosis intervention. The present review summarizes findings from the recent 2¾ years including the ability of NaF-PET imaging to assess disease progress and evaluate response to treatment. Despite valuable new information, pertinent questions remain unanswered, not least due to a pronounced lack of standardization within the field and of well-designed long-term studies illuminating the natural history of atherosclerosis and effects of intervention.
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Patel NR, Setya K, Pradhan S, Lu M, Demer LL, Tintut Y. Microarchitectural Changes of Cardiovascular Calcification in Response to In Vivo Interventions Using Deep-Learning Segmentation and Computed Tomography Radiomics. Arterioscler Thromb Vasc Biol 2022; 42:e228-e241. [PMID: 35708025 PMCID: PMC9339530 DOI: 10.1161/atvbaha.122.317761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary calcification associates closely with cardiovascular risk, but its progress is accelerated in response to some interventions widely used to reduce risk. This paradox suggests that qualitative, not just quantitative, changes in calcification may affect plaque stability. To determine if the microarchitecture of calcification varies with aging, Western diet, statin therapy, and high intensity, progressive exercise, we assessed changes in a priori selected computed tomography radiomic features (intensity, size, shape, and texture). METHODS Longitudinal computed tomography scans of mice (Apoe-/-) exposed to each of these conditions were autosegmented by deep learning segmentation, and radiomic features of the largest deposits were analyzed. RESULTS Over 20 weeks of aging, intensity and most size parameters increased, but surface-area-to-volume ratio (a measure of porosity) decreased, suggesting stabilization. However, texture features (coarseness, cluster tendency, and nonuniformity) increased, suggesting heterogeneity and likely destabilization. Shape parameters showed no significant changes, except sphericity, which showed a decrease. The Western diet had significant effects on radiomic features related to size and texture, but not intensity or shape. In mice undergoing either pravastatin treatment or exercise, the selected radiomic features of their computed tomography scans were not significantly different from those of their respective controls. Interestingly, the total number of calcific deposits increased significantly less in the 2 intervention groups compared with the respective controls, suggesting more coalescence and/or fewer de novo deposits. CONCLUSIONS Thus, aging and standard interventions alter the microarchitectural features of vascular calcium deposits in ways that may alter plaque biomechanical stability.
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Affiliation(s)
- Nikhil Rajesh Patel
- Department of Medicine, University of California, Los Angeles. (N.R.P., K.S., S.P., M.L., L.L.D., Y.T.)
| | - Kulveer Setya
- Department of Medicine, University of California, Los Angeles. (N.R.P., K.S., S.P., M.L., L.L.D., Y.T.)
| | - Stuti Pradhan
- Department of Medicine, University of California, Los Angeles. (N.R.P., K.S., S.P., M.L., L.L.D., Y.T.)
| | - Mimi Lu
- Department of Medicine, University of California, Los Angeles. (N.R.P., K.S., S.P., M.L., L.L.D., Y.T.)
| | - Linda L Demer
- Department of Medicine, University of California, Los Angeles. (N.R.P., K.S., S.P., M.L., L.L.D., Y.T.).,Department of Bioengineering, University of California, Los Angeles. (L.L.D.).,Department of Physiology, University of California, Los Angeles. (L.L.D., Y.T.).,VA Greater Los Angeles Healthcare System, CA (L.L.D., Y.T.)
| | - Yin Tintut
- Department of Medicine, University of California, Los Angeles. (N.R.P., K.S., S.P., M.L., L.L.D., Y.T.).,Department of Physiology, University of California, Los Angeles. (L.L.D., Y.T.).,Department of Orthopaedic Surgery, University of California, Los Angeles. (Y.T.).,VA Greater Los Angeles Healthcare System, CA (L.L.D., Y.T.)
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