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157 18F-sodium fluoride positron emission tomography, aortic disease activity and ischaemic stroke risk
  1. Alexander Fletcher1,
  2. Evangelos Tzolos1,
  3. Shruti Joshi1,
  4. Jacek Kwiecinski2,
  5. Rong Bing1,
  6. Maaz Syed3,
  7. Mhairi Doris1,
  8. Edwin van Beek1,
  9. Alistiar Moss1,
  10. Niki Walker4,
  11. Nikhil Joshi5,
  12. Tania Pawade1,
  13. Philip Adamson6,
  14. William Whiteley7,
  15. Joanna Wardlaw7,
  16. Piotr Slomka8,
  17. Michelle Williams1,
  18. David Newby1,
  19. Marc Dweck1
  1. 1Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
  2. 2Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw
  3. 3BHF Department for Cardiovascular Sciences, University of Edinburgh
  4. 4Golden Jubilee National Hosptial
  5. 5Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol
  6. 6Christchurch Heart Institute, University of Otago, Christchurch
  7. 7Centre for Clinical Brain Sciences, University of Edinburgh
  8. 8Cedars-Sinai Medical Centre, Department of Imaging (Division of Nuclear Cardiology), Los Angeles, Un


Background Arterial 18F-sodium fluoride (18F-NaF) activity on positron emission tomography (PET) is a marker of active microcalcification and atherosclerosis. Coronary 18F-NaF activity (CMA) predicts coronary artery disease progression and subsequent myocardial infarction. We aimed to investigate whether aortic 18F-NaF activity (AMA) predicts thoracic aortic atherosclerotic disease progression and subsequent ischaemic stroke in patients with established cardiovascular disease.

Methods In a post-hoc observational cohort study, we evaluated AMA in patients with stable coronary artery disease (n=239) or aortic stenosis (n=158) who had underwent thoracic 18F-NaF PET and computed tomography (CT). We assessed the associations between AMA and progression of thoracic aortic calcification on follow up CT and subsequent ischaemic stroke or myocardial infarction.

Results In 141 patients with repeat CT imaging at 12.7±2.7 months, AMA correlated with progression of thoracic aortic calcium scores (r=0.21, p=0.011). In 397 patients, 16 had an ischaemic stroke and 25 had a myocardial infarction after 4.7±1.6 years. After adjusting for clinical risk factors, CMA and calcium scoring, AMA was associated with stroke (hazard ratio, 1.71 [95% confidence interval 1.00-2.90], p=0.048]). AMA was superior to clinical risk and calcium scores in identifying patients with stroke (c-statistic 0.76 versus 0.58 versus 0.63 respectively, p<0.05). Survival analysis demonstrated that AMA was associated with ischaemic stroke (p<0.001) but not myocardial infarction (p=0.45), whereas CMA was associated with myocardial infarction (p<0.001) but not stroke (p=0.39).

Conclusions In patients with established cardiovascular disease, AMA is associated with progression of aortic atherosclerosis and future ischaemic stroke. Arterial 18F-NaF identifies localised areas of atherosclerotic disease activity that relate to regional atherothrombotic events.

Conflict of Interest none to delcare

  • stroke
  • positron emission tomography
  • atherosclerosis

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