Skip to main content
SpringerLink
Log in

Relation between thoracic aortic inflammation and features of plaque vulnerability in the coronary tree in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. An FDG-positron emission tomography and optical coherence tomography study

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the relationship between aortic inflammation as assessed by 18F–fluorodeoxyglucose-positron emission tomography (18F–FDG-PET) and features of plaque vulnerability as assessed by frequency domain-optical coherence tomography (FD-OCT).

Methods

We enrolled 30 consecutive non-ST-segment elevation acute coronary syndrome patients undergoing percutaneous coronary intervention. All patients underwent three-vessel OCT before intervention and 18F–FDG-PET before discharge. Univariable and C-reactive protein (CRP)-adjusted linear regression analyses were performed between features of vulnerability [namely:lipid-rich plaques with and without macrophages and thin cap fibroatheromas (TCFA)] and 18F–FDG uptake in both ascending (AA) and descending aorta (DA) [measured either as averaged mean and maximum target-to-blood ratio (TBR) or as active slices (TBRmax ≥ 1.6)].

Results

Mean age was 62 years, and 26 patients were male. On univariable linear regression analysis TBRmean and TBRmax in DA was associated with the number of lipid-rich plaques (β = 4.22; 95%CI 0.05–8.39; p = 0.047 and β = 3.72; 95%CI 1.14–6.30; p = 0.006, respectively). TBRmax in DA was also associated with the number of lipid-rich plaques containing macrophages (β = 2.40; 95%CI 0.07–4.72; p = 0.044). A significant CRP adjusted linear association between the TBRmax in DA and the number of lipid-rich plaques was observed (CRP-adjusted β = 3.58; 95%CI -0.91-6.25; p = 0.01). TBRmax in DA showed a trend towards significant CRP-adjusted association with number of lipid-rich plaques with macrophages (CRP-adjusted β = 2.30; 95%CI -0.11-4.71; p = 0.06). We also observed a CRP-adjusted (β = 2.34; 95%CI 0.22–4.47; p = 0.031) linear association between the number of active slices in DA and the number of lipid-rich plaques. No relation was found between FDG uptake in the aorta and the number of TCFAs.

Conclusions

In patients with first NSTEACS, 18F–FDG uptake in DA is correlated with the number of OCT detected lipid-rich plaques with or without macrophages. This association may be independent from CRP values.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation. 2001;104:2855–64.

    Article  CAS  PubMed  Google Scholar 

  2. Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. J am Coll Cardiol. 2006;47:C13–8.

    Article  CAS  PubMed  Google Scholar 

  3. Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol. 2000;20:1262–75.

    Article  CAS  PubMed  Google Scholar 

  4. Libby P. Inflammation in atherosclerosis. Nature. 2002;420:868–74.

    Article  CAS  PubMed  Google Scholar 

  5. Moreno PR, Falk E, Palacios IF, Newell JB, Fuster V, Fallon JT. Macrophage infiltration in acute coronary syndromes. Implications for plaque rupture. Circulation. 1994;90:775–8.

    Article  CAS  PubMed  Google Scholar 

  6. Rudd JH, Warburton EA, Fryer TD, et al. Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation. 2002;105:2708–11.

    Article  CAS  PubMed  Google Scholar 

  7. Rudd JH, Narula J, Strauss HW, et al. Imaging atherosclerotic plaque inflammation by fluorodeoxyglucose with positron emission tomography: ready for prime time? J am Coll Cardiol. 2010;55:2527–35.

    Article  PubMed  Google Scholar 

  8. Aziz K, Berger K, Claycombe K, Huang R, Patel R, Abela GS. Noninvasive detection and localization of vulnerable plaque and arterial thrombosis with computed tomography angiography/positron emission tomography. Circulation. 2008;117:2061–70.

    Article  PubMed  Google Scholar 

  9. Tatsumi M, Cohade C, Nakamoto Y, Wahl RL. Fluorodeoxyglucose uptake in the aortic wall at PET/CT: possible finding for active atherosclerosis. Radiology. 2003;229:831–7.

    Article  PubMed  Google Scholar 

  10. Tawakol A, Migrino RQ, Bashian GG, et al. In vivo 18F-fluorodeoxyglucose positron emission tomography imaging provides a noninvasive measure of carotid plaque inflammation in patients. J am Coll Cardiol. 2006;48:1818–24.

    Article  PubMed  Google Scholar 

  11. Menezes LJ, Kotze CW, Agu O, et al. Investigating vulnerable atheroma using combined (18)F-FDG PET/CT angiography of carotid plaque with immunohistochemical validation. J Nucl med. 2011;52:1698–703.

    Article  PubMed  Google Scholar 

  12. Rudd JH, Myers KS, Bansilal S, et al. (18)Fluorodeoxyglucose positron emission tomography imaging of atherosclerotic plaque inflammation is highly reproducible: implications for atherosclerosis therapy trials. J am Coll Cardiol. 2007;50:892–6.

    Article  PubMed  Google Scholar 

  13. Rudd JH, Myers KS, Bansilal S, et al. Relationships among regional arterial inflammation, calcification, risk factors, and biomarkers: a prospective fluorodeoxyglucose positron-emission tomography/computed tomography imaging study. Circ Cardiovasc Imaging. 2009;2:107–15.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rogers IS, Nasir K, Figueroa AL, et al. Feasibility of FDG imaging of the coronary arteries: comparison between acute coronary syndrome and stable angina. JACC Cardiovasc Imaging. 2010;3:388–97.

    Article  PubMed  Google Scholar 

  15. Cheng VY, Slomka PJ, Le Meunier L, et al. Coronary arterial 18F-FDG uptake by fusion of PET and coronary CT angiography at sites of percutaneous stenting for acute myocardial infarction and stable coronary artery disease. J Nucl med. 2012;53:575–83.

    Article  CAS  PubMed  Google Scholar 

  16. Joshi NV, Vesey AT, Williams MC, et al. 18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial. Lancet. 2014;383:705–13.

    Article  PubMed  Google Scholar 

  17. Yu S. Review of F-FDG synthesis and quality control. Biomed Imaging Interv J. 2006;2:e57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Figueroa AL, Abdelbaky A, Truong QA, et al. Measurement of arterial activity on routine FDG PET/CT images improves prediction of risk of future CV events. JACC Cardiovasc Imaging. 2013;6:1250–9.

    Article  PubMed  Google Scholar 

  19. Prati F, Regar E, Mintz GS, et al. Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J. 2010;31:401–15.

    Article  PubMed  Google Scholar 

  20. Bucerius J, Mani V, Moncrieff C, et al. Optimizing 18F-FDG PET/CT imaging of vessel wall inflammation: the impact of 18F-FDG circulation time, injected dose, uptake parameters, and fasting blood glucose levels. Eur J Nucl med Mol Imaging. 2014;41:369–83.

    Article  CAS  PubMed  Google Scholar 

  21. Otsuka F, Joner M, Prati F, Virmani R, Narula J. Clinical classification of plaque morphology in coronary disease. Nat rev Cardiol. 2014;11:379–89.

    Article  PubMed  Google Scholar 

  22. Tearney GJ, Regar E, Akasaka T, et al. Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the international working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J am Coll Cardiol. 2012;59:1058–72.

    Article  PubMed  Google Scholar 

  23. Di Vito L, Agozzino M, Marco V, et al. Identification and quantification of macrophage presence in coronary atherosclerotic plaques by optical coherence tomography. Eur Heart J Cardiovasc Imaging. 2015;16:807–13.

    Article  PubMed  Google Scholar 

  24. Wykrzykowska J, Lehman S, Williams G, et al. Imaging of inflamed and vulnerable plaque in coronary arteries with 18F-FDG PET/CT in patients with suppression of myocardial uptake using a low-carbohydrate, high-fat preparation. J Nucl med. 2009;50:563–8.

    Article  PubMed  Google Scholar 

  25. Bucerius J, Hyafil F, Verberne HJ, et al. Position paper of the cardiovascular Committee of the European Association of nuclear medicine (EANM) on PET imaging of atherosclerosis. Eur J Nucl med Mol Imaging. 2016;43:780–92.

    Article  PubMed  Google Scholar 

  26. Tahara N, Kai H, Ishibashi M, et al. Simvastatin attenuates plaque inflammation: evaluation by fluorodeoxyglucose positron emission tomography. J am Coll Cardiol. 2006;48:1825–31.

    Article  CAS  PubMed  Google Scholar 

  27. Elkhawad M, Rudd JH, Sarov-Blat L, et al. Effects of p38 mitogen-activated protein kinase inhibition on vascular and systemic inflammation in patients with atherosclerosis. JACC Cardiovasc Imaging. 2012;5:911–22.

    Article  PubMed  Google Scholar 

  28. Marzocchi A, Taglieri N, Saia F, et al. Incidence, treatment and outcome of acute coronary syndromes: a community-based study in the era of myocardial infarction networks. Int J Cardiol. 2012;157:419–22.

    Article  PubMed  Google Scholar 

  29. Fox KA, Poole-Wilson P, Clayton TC, et al. 5-year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial. Lancet. 2005;366:914–20.

    Article  CAS  PubMed  Google Scholar 

  30. Stone JR, Bruneval P, Angelini A, et al. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovasc Pathol. 2015;24:267–78.

    Article  PubMed  Google Scholar 

  31. Hattori K, Ozaki Y, Ismail TF, et al. Impact of statin therapy on plaque characteristics as assessed by serial OCT, grayscale and integrated backscatter-IVUS. JACC Cardiovasc Imaging. 2012;5:169–77.

    Article  PubMed  Google Scholar 

  32. Stone GW, Maehara A, Lansky AJ, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J med. 2011;364:226–35.

    Article  CAS  PubMed  Google Scholar 

  33. Tian J, Ren X, Vergallo R, et al. Distinct morphological features of ruptured culprit plaque for acute coronary events compared to those with silent rupture and thin-cap fibroatheroma: a combined optical coherence tomography and intravascular ultrasound study. J am Coll Cardiol. 2014;63:2209–16.

    Article  PubMed  Google Scholar 

  34. Oh M, Lee CW, Lee HS, et al. Similar impact of Clopidogrel or Ticagrelor on carotid atherosclerotic plaque inflammation. Clin Cardiol. 2016;39:646–52.

    Article  PubMed  Google Scholar 

  35. Su B, Xu B, Wan J. Correlation between long-term aspirin use and F-fluorodeoxyglucose uptake in colorectal cancer measured by PET/CT. PLoS One. 2014;9:e109459.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Scholtens AM, Verberne HJ, Budde RP, Lam MG. Additional heparin Preadministration improves cardiac glucose metabolism suppression over low-carbohydrate Diet alone in (1)(8)F-FDG PET imaging. J Nucl med. 2016;57:568–73.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Istituto di Cardiologia, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Via Massarenti 9, 40138, Bologna, Italy

    Nevio Taglieri, Gabriele Ghetti, Francesco Saia, Maria Letizia Bacchi Reggiani & Claudio Rapezzi

  2. Istituto di Medicina Nucleare, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna, Italy

    Cristina Nanni, Rachele Bonfiglioli, Giacomo Maria Lima & Stefano Fanti

  3. CLI Foundation, Rome, Italy

    Valeria Marco & Francesco Prati

  4. GVM Care & Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy

    Francesco Prati

Authors
  1. Nevio Taglieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Nanni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriele Ghetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rachele Bonfiglioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesco Saia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Letizia Bacchi Reggiani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giacomo Maria Lima
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Valeria Marco
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francesco Prati
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Stefano Fanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Claudio Rapezzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nevio Taglieri.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

This work was supported by Department of Experimental, Diagnostic and Speciality Medicine - DIMES, University of Bologna and by Fanti Melloni Foundation (grant number = not applicable).

Conflict of interest

F.P. is a consultant for ST. Jude Medical. The remaining authors have no conflicts of interest to declare.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Table S1

(DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taglieri, N., Nanni, C., Ghetti, G. et al. Relation between thoracic aortic inflammation and features of plaque vulnerability in the coronary tree in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. An FDG-positron emission tomography and optical coherence tomography study. Eur J Nucl Med Mol Imaging 44, 1878–1887 (2017). https://doi.org/10.1007/s00259-017-3747-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-017-3747-8

Keywords

Search

Navigation