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Prognostic value of cardiac inflammation in ST-segment elevation myocardial infarction: A 18F-fluorodeoxyglucose PET/CT study

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

18F-fluorodeoxyglucose (FDG) imaging is used to detect cardiac inflammation and predict functional outcome in acute myocardial infarction (MI). However, data on the correlation of post-MI acute cardiac inflammation evaluated by 18F-FDG imaging and major adverse cardiac events (MACE) are limited. Therefore, we sought to explore the prognostic value of cardiac 18F-FDG imaging in patients with acute ST-segment elevation MI (STEMI).

Methods

Thirty-six patients with STEMI underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) 5 days after primary percutaneous coronary intervention. 18F-FDG activity in infarcted and remote regions, as well as peri-coronary adipose tissue (PCAT), were measured and expressed as the maximum standardized uptake value (SUVmax). Patients were followed to determine the occurrence of MACE.

Results

The infarcted myocardium had a higher 18F-FDG intensity than the remote area. Moreover, the PCAT of culprit coronary arteries showed a higher 18F-FDG uptake than that of non-culprit arteries. Multivariate Cox regression analysis showed that increased SUVmax of PCAT [HR 5.198; 95% CI (1.058, 25.537), P = .042] was independently associated with a higher risk of MACE.

Conclusions

Enhanced PCAT activity after acute MI is related to the occurrence of MACE, and 18F-FDG PET/CT plays a promising role in providing prognostic information in patients with STEMI.

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Abbreviations

MI:

Myocardial infarction

FDG:

Fluorodeoxyglucose

PET/CT:

Positron emission tomography/computerized tomography

MACE:

Major adverse cardiac events

PCAT:

Peri-coronary adipose tissue

PCI:

Percutaneous coronary intervention

SUV:

Standardized uptake value

RCA:

Right coronary artery

LCX:

Left circumflex artery

LAD:

Left anterior descending artery

References

  1. Anderson JL, Morrow DA. Acute myocardial infarction. N Engl J Med 2017;376:2053‐64.

    Article  CAS  Google Scholar 

  2. Ezekowitz JA, Kaul P, Bakal JA, Armstrong PW, Welsh RC, McAlister FA. Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction. J Am Coll Cardiol 2009;53:13‐20.

    Article  Google Scholar 

  3. Frangogiannis NG. Pathophysiology of myocardial infarction. Compr Physiol. 2015;5:1841‐75.

    Article  Google Scholar 

  4. Rischpler C, Dirschinger RJ, Nekolla SG, Kossmann H, Nicolosi S, Hanus F. Prospective evaluation of 18F-fluorodeoxyglucose uptake in postischemic myocardium by simultaneous positron emission tomography/magnetic resonance imaging as a prognostic marker of functional outcome. Circ Cardiovasc Imaging 2016;9:e004316.

    Article  Google Scholar 

  5. Ramos IT, Henningsson M, Nezafat M, Lavin B, Lorrio S, Gebhardt P, et al. Simultaneous assessment of cardiac inflammation and extracellular matrix remodeling after myocardial infarction. Circ Cardiovasc Imaging 2018;11:e007453.

    Article  Google Scholar 

  6. Dall’Armellina E, Piechnik SK, Ferreira VM, Si QL, Robson MD, Francis JM, et al. Cardiovascular magnetic resonance by non contrast T1-mapping allows assessment of severity of injury in acute myocardial infarction. J Cardiovasc Magn Reson 2012;14:15.

    Article  Google Scholar 

  7. Kidambi A, Motwani M, Uddin A, Ripley DP, McDiarmid AK, Swoboda PP, et al. Myocardial extracellular volume estimation by CMR predicts functional recovery following acute MI. JACC Cardiovasc imaging 2017;10:989‐99.

    Article  Google Scholar 

  8. Wollenweber T, Roentgen P, Schafer A, Schatka I, Zwadlo C, Brunkhorst T, et al. Characterizing the inflammatory tissue response to acute myocardial infarction by clinical multimodality noninvasive imaging. Circ Cardiovasc Imaging 2014;7:811‐8.

    Article  Google Scholar 

  9. Lee WW, Marinelli B, van der Laan AM, Sena BF, Gorbatov R, Leuschner F, et al. PET/MRI of inflammation in myocardial infarction. J Am Coll Cardiol 2012;59:153‐63.

    Article  CAS  Google Scholar 

  10. Wilk B, Smailovic H, Wisenberg G, Sykes J, Butler J, Kovacs M, et al. Tracking the progress of inflammation with PET/MRI in a canine model of myocardial infarction. J Nucl Cardiol 2021. https://doi.org/10.1007/s12350-020-02487-5.

    Article  Google Scholar 

  11. Mazurek T, Kobylecka M, Zielenkiewicz M, Kurek A, Kochman J, Filipiak KJ, et al. PET/CT evaluation of 18F-FDG uptake in pericoronary adipose tissue in patients with stable coronary artery disease: Independent predictor of atherosclerotic lesions’ formation? J Nucl Cardiol 2017;24:1075‐84.

    Article  Google Scholar 

  12. van Diemen PA, Bom MJ, Driessen RS, Schumacher SP, Everaars H, de Winter RW, et al. Prognostic value of RCA pericoronary adipose tissue CT-attenuation beyond high-risk plaques, plaque volume, and ischemia. JACC Cardiovasc imaging 2021. https://doi.org/10.1016/j.jcmg.2021.02.026.

    Article  Google Scholar 

  13. Oikonomou EK, Marwan M, Desai MY, Mancio J, Alashi A, Centeno EH, et al. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): A post-hoc analysis of prospective outcome data. Lancet 2018;392:929‐39.

    Article  Google Scholar 

  14. Mazurek T, Kiliszek M, Kobylecka M, Skubisz-Gluchowska J, Kochman J, Filipiak K, et al. Relation of proinflammatory activity of epicardial adipose tissue to the occurrence of atrial fibrillation. Am J Cardiol 2014;113:1505‐8.

    Article  Google Scholar 

  15. Thygesen K, Alpert J, Jaffe A, Simoons M, Chaitman B, White H, et al. Third universal definition of myocardial infarction. Circulation 2012;126:2020‐35.

    Article  Google Scholar 

  16. Xi XY, Zhang F, Wang J, Gao W, Tian Y, Xu H, et al. Functional significance of post-myocardial infarction inflammation evaluated by 18F-fluorodeoxyglucose imaging in swine model. J Nucl Cardiol 2020;27:519‐31.

    Article  Google Scholar 

  17. Mazurek T, Zhang L, Zalewski A, Mannion JD, Diehl JT, Arafat H, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation 2003;108:2460‐6.

    Article  Google Scholar 

  18. Cherian S, Lopaschuk GD, Carvalho E. Cellular cross-talk between epicardial adipose tissue and myocardium in relation to the pathogenesis of cardiovascular disease. Am J Physiol Endocrinol Metab 2012;303:E937‐49.

    Article  CAS  Google Scholar 

  19. Keegan J, Gatehouse PD, Yang GZ, Firmin DN. Spiral phase velocity mapping of left and right coronary artery blood flow: Correction for through-plane motion using selective fat-only excitation. J Magn Reson Imaging 2004;20:953‐60.

    Article  Google Scholar 

  20. Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: Anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2005;2:536‐43.

    Article  Google Scholar 

  21. Berg G, Miksztowicz V, Morales C, Barchuk M. Epicardial adipose tissue in cardiovascular disease. Adv Exp Med Biol 2019;1127:131‐43.

    Article  CAS  Google Scholar 

  22. Dozio E, Vianello E, Briganti S, Fink B, Malavazos AE, Scognamiglio ET, et al. Increased reactive oxygen species production in epicardial adipose tissues from coronary artery disease patients is associated with brown-to-white adipocyte trans-differentiation. Int J Cardiol 2014;174:413‐4.

    Article  Google Scholar 

  23. Goeller M, Achenbach S, Cadet S, Kwan AC, Commandeur F, Slomka PJ, et al. pericoronary adipose tissue computed tomography attenuation and high-risk plaque characteristics in acute coronary syndrome compared with stable coronary artery disease. JAMA Cardiol 2018;3:858‐63.

    Article  Google Scholar 

  24. Cabrera-Rego JO, Escobar-Torres RA, Parra-Jiménez JD, Valiente-Mustelier J. Epicardial fat thickness correlates with coronary in-stent restenosis in patients with acute myocardial infarction. Clin Investig Arterioscler 2019;31:49‐55.

    Google Scholar 

  25. Balcer B, Dykun I, Schlosser T, Forsting M, Rassaf T, Mahabadi AA. Pericoronary fat volume but not attenuation differentiates culprit lesions in patients with myocardial infarction. Atherosclerosis 2018;276:182‐8.

    Article  CAS  Google Scholar 

  26. Tscharre M, Hauser C, Rohla M, Freynhofer MK, Wojta J, Huber K, et al. Epicardial adipose tissue and cardiovascular outcome in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Eur Heart J Acute Cardiovasc Care 2017;6:750‐2.

    Article  Google Scholar 

  27. Kwiecinski J, Dey D, Cadet S, Lee SE, Otaki Y, Huynh PT, et al. Peri-coronary adipose tissue density is associated with 18F-sodium fluoride coronary uptake in stable patients with high-risk plaques. JACC Cardiovasc Imaging 2019;12:2000‐10.

    Article  Google Scholar 

  28. Antonopoulos AS, Sanna F, Sabharwal N, Thomas S, Oikonomou EK, Herdman L, et al. Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med 2017;9:eaal2658.

    Article  Google Scholar 

  29. Hedgire S, Baliyan V, Zucker EJ, Bittner DO, Staziaki PV, Takx RAP, et al. Perivascular epicardial fat stranding at coronary CT angiography: A marker of acute plaque rupture and spontaneous coronary artery dissection. Radiology 2018;287:808‐15.

    Article  Google Scholar 

  30. Gao W, Gong J-N, Guo X-J, Wu J-Y, Xi X-Y, Ma Z-H, et al. Value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the evaluation of pulmonary artery activity in patients with Takayasu’s arteritis. Eur Heart J Cardiovasc Imaging 2021;22:541‐50.

    Article  Google Scholar 

  31. Westman PC, Lipinski MJ, Luger D, Waksman R, Bonow RO, Wu E, et al. Inflammation as a driver of adverse left ventricular remodeling after acute myocardial infarction. J Am Coll Cardiol 2016;67:2050‐60.

    Article  Google Scholar 

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Disclosures

Xiao-Ying Xi, Ze Liu, Le-Feng Wang, and Min-Fu Yang have no conflicts of interest to declare.

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Author notes

  1. Xiao-Ying Xi and Ze Liu have contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China

    Xiao-Ying Xi MD & Min-Fu Yang MD

  2. Department of Cardiology, Peking University Third Hospital Yanqing Hospital, Beijing, 102100, China

    Ze Liu MD

  3. Center of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China

    Le-Feng Wang MD

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  1. Xiao-Ying Xi MD
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  2. Ze Liu MD
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Correspondence to Le-Feng Wang MD or Min-Fu Yang MD.

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Funding This study was supported by Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (ZYLX202105)

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Xi, XY., Liu, Z., Wang, LF. et al. Prognostic value of cardiac inflammation in ST-segment elevation myocardial infarction: A 18F-fluorodeoxyglucose PET/CT study. J. Nucl. Cardiol. 29, 3018–3027 (2022). https://doi.org/10.1007/s12350-021-02858-6

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  • DOI: https://doi.org/10.1007/s12350-021-02858-6

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