Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Application of Non-invasive Imaging in Inflammatory Disease Conditions to Evaluate Subclinical Coronary Artery Disease

  • 123 Accesses


Purpose of Review

Traditional risk models, such as the Framingham risk score, fail to capture the increased cardiovascular disease risk seen in patients with chronic inflammatory diseases. This review will cover imaging modalities and their emerging applications in assessing subclinical cardiovascular disease for both research and clinical care in patients with chronic inflammatory diseases.

Recent Findings

Multiple imaging modalities have been studied to assess for subclinical cardiovascular disease via functional/physiologic, inflammatory, and anatomic assessment in patients with chronic inflammatory diseases.


The use of imaging to evaluate subclinical cardiovascular disease in patients with chronic inflammatory diseases has the potential to capture early sub-clinical atherosclerosis, to improve risk stratification of future cardiovascular events, and to guide effective disease management.

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

Fig. 1


  1. 1.

    Willerson JT, Ridker PM. Inflammation as a Cardiovascular Risk Factor. Circulation. 2004;109:II–2.

  2. 2.

    Aviña-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008;59:1690–7.

  3. 3.

    Mehta NN, Yu Y, Pinnelas R, Krishnamoorthy P, Shin DB, Troxel AB, et al. Attributable risk estimate of severe psoriasis on major cardiovascular events. Am J Med. 2011;124:775.e1-6.

  4. 4.

    Gelfand JM, Dommasch ED, Shin DB, Azfar RS, Kurd SK, Wang X, et al. The risk of stroke in patients with psoriasis. J Invest Dermatol. 2009;129:2411–8.

  5. 5.

    Gu M-M, Wang X-P, Cheng Q-Y, Zhao Y-L, Zhang T-P, Li B-Z, et al. A Meta-Analysis of Cardiovascular Events in Systemic Lupus Erythematosus. Immunol Invest. 2019:1–16.

  6. 6.

    Bacon PA, Stevens RJ, Carruthers DM, Young SP, Kitas GD. Accelerated atherogenesis in autoimmune rheumatic diseases. Autoimmun Rev. 2002;1:338–47.

  7. 7.

    Zeller CB, Appenzeller S. Cardiovascular Disease in Systemic Lupus Erythematosus: The Role of Traditional and Lupus Related Risk Factors. Curr Cardiol Rev. 2008;4:116–22.

  8. 8.

    Sinicato NA, da Silva Cardoso PA, Appenzeller S. Risk Factors in Cardiovascular Disease in Systemic Lupus Erythematosus. Curr Cardiol Rev. 2013;9:15–9.

  9. 9.

    Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006;296:1735–41.

  10. 10.

    Mehta NN, Azfar RS, Shin DB, Neimann AL, Troxel AB, Gelfand JM. Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database. Eur Heart J. 2010;31:1000–6.

  11. 11.

    Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S49–73.

  12. 12.

    Reriani MK, Lerman LO, Lerman A. Endothelial function as a functional expression of cardiovascular risk factors. Biomark Med. 2010;4:351–60.

  13. 13.

    Alam TA, Seifalian AM, Baker D. A review of methods currently used for assessment of in vivo endothelial function. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg. 2005;29:269–76.

  14. 14.

    Joannides R, Haefeli WE, Linder L, Richard V, Bakkali EH, Thuillez C, et al. Nitric oxide is responsible for flow-dependent dilatation of human peripheral conduit arteries in vivo. Circulation. 1995;91:1314–9.

  15. 15.

    Celermajer DS. Reliable endothelial function testing: at our fingertips? Circulation. 2008;117:2428–30.

  16. 16.

    Kuvin JT, Patel AR, Sliney KA, Pandian NG, Sheffy J, Schnall RP, et al. Assessment of peripheral vascular endothelial function with finger arterial pulse wave amplitude. Am Heart J. 2003;146:168–74.

  17. 17.

    Bonetti PO, Pumper GM, Higano ST, Holmes DR, Kuvin JT, Lerman A. Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia. J Am Coll Cardiol. 2004;44:2137–41.

  18. 18.

    Targonski PV, Bonetti PO, Pumper GM, Higano ST, Holmes DR, Lerman A. Coronary endothelial dysfunction is associated with an increased risk of cerebrovascular events. Circulation. 2003;107:2805–9.

  19. 19.

    Matsuzawa Y, Kwon T-G, Lennon RJ, Lerman LO, Lerman A. Prognostic Value of Flow-Mediated Vasodilation in Brachial Artery and Fingertip Artery for Cardiovascular Events: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2015;4.

  20. 20.

    Charakida M, de Groot E, Loukogeorgakis SP, Khan T, Lüscher T, Kastelein JJ, et al. Variability and reproducibility of flow-mediated dilatation in a multicentre clinical trial. Eur Heart J. 2013;34:3501–7.

  21. 21.

    Rubinshtein R, Kuvin JT, Soffler M, Lennon RJ, Lavi S, Nelson RE, et al. Assessment of endothelial function by non-invasive peripheral arterial tonometry predicts late cardiovascular adverse events. Eur Heart J. 2010;31:1142–8.

  22. 22.

    Castellon X, Bogdanova V. Chronic Inflammatory Diseases and Endothelial Dysfunction. Aging Dis. 2016;7:81–9.

  23. 23.

    Chatterjee Adhikari M, Guin A, Chakraborty S, Sinhamahapatra P, Ghosh A. Subclinical atherosclerosis and endothelial dysfunction in patients with early rheumatoid arthritis as evidenced by measurement of carotid intima-media thickness and flow-mediated vasodilatation: an observational study. Semin Arthritis Rheum. 2012;41:669–75.

  24. 24.

    Vaudo G, Marchesi S, Gerli R, Allegrucci R, Giordano A, Siepi D, et al. Endothelial dysfunction in young patients with rheumatoid arthritis and low disease activity. Ann Rheum Dis. 2004;63:31–5.

  25. 25.

    Foster W, Lip GYH, Raza K, Carruthers D, Blann AD. An observational study of endothelial function in early arthritis. Eur J Clin Invest. 2012;42:510–6.

  26. 26.

    Sandoo A. Veldhuijzen van Zanten JJCS, Metsios GS, Carroll D, Kitas GD. Vascular function and morphology in rheumatoid arthritis: a systematic review. Rheumatol Oxf Engl. 2011;50:2125–39.

  27. 27.

    Kiss E, Soltesz P, Der H, Kocsis Z, Tarr T, Bhattoa H, et al. Reduced flow-mediated vasodilation as a marker for cardiovascular complications in lupus patients. J Autoimmun. 2006;27:211–7.

  28. 28.

    El-Magadmi M, Bodill H, Ahmad Y, Durrington PN, Mackness M, Walker M, et al. Systemic lupus erythematosus: an independent risk factor for endothelial dysfunction in women. Circulation. 2004;110:399–404.

  29. 29.

    Piper MK, Raza K, Nuttall SL, Stevens R, Toescu V, Heaton S, et al. Impaired endothelial function in systemic lupus erythematosus. Lupus. 2007;16:84–8.

  30. 30.

    Wright SA, O’Prey FM, Rea DJ, Plumb RD, Gamble AJ, Leahey WJ, et al. Microcirculatory hemodynamics and endothelial dysfunction in systemic lupus erythematosus. Arterioscler Thromb Vasc Biol. 2006;26:2281–7.

  31. 31.

    Sari I, Okan T, Akar S, Cece H, Altay C, Secil M, et al. Impaired endothelial function in patients with ankylosing spondylitis. Rheumatol Oxf Engl. 2006;45:283–6.

  32. 32.

    Gonzalez-Juanatey C, Llorca J, Miranda-Filloy JA, Amigo-Diaz E, Testa A, Garcia-Porrua C, et al. Endothelial dysfunction in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis Rheum. 2007;57:287–93.

  33. 33.

    Bodnár N, Kerekes G, Seres I, Paragh G, Kappelmayer J, Némethné ZG, et al. Assessment of subclinical vascular disease associated with ankylosing spondylitis. J Rheumatol. 2011;38:723–9.

  34. 34.

    Fang N, Jiang M, Fan Y. Association Between Psoriasis and Subclinical Atherosclerosis. Medicine (Baltimore) [Internet]. 2016 [cited 2019 Aug 13];95. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902401/

  35. 35.

    von Stebut E, Reich K, Thaçi D, Koenig W, Pinter A, Körber A, et al. Impact of Secukinumab on Endothelial Dysfunction and Other Cardiovascular Disease Parameters in Psoriasis Patients over 52 Weeks. J Invest Dermatol. 2019;139:1054–62.

  36. 36.

    Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler Thromb Vasc Biol. 2005;25:932–43.

  37. 37.

    Cecelja M, Chowienczyk P. Role of arterial stiffness in cardiovascular disease. JRSM Cardiovasc Dis. 2012;1.

  38. 38.

    Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27:2588–605.

  39. 39.

    Kullo IJ, Malik AR. Arterial ultrasonography and tonometry as adjuncts to cardiovascular risk stratification. J Am Coll Cardiol. 2007;49:1413–26.

  40. 40.

    Mitchell GF, Hwang S-J, Vasan RS, Larson MG, Pencina MJ, Hamburg NM, et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation. 2010;121:505–11.

  41. 41.

    Reference Values for Arterial Stiffness’ Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: “establishing normal and reference values.” Eur Heart J. 2010;31:2338–2350.

  42. 42.

    Meaume S, Benetos A, Henry OF, Rudnichi A, Safar ME. Aortic pulse wave velocity predicts cardiovascular mortality in subjects >70 years of age. Arterioscler Thromb Vasc Biol. 2001;21:2046–50.

  43. 43.

    Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertens Dallas Tex 1979. 2001;37:1236–41.

  44. 44.

    van Popele NM, Mattace-Raso FUS, Vliegenthart R, Grobbee DE, Asmar R, van der Kuip DAM, et al. Aortic stiffness is associated with atherosclerosis of the coronary arteries in older adults: the Rotterdam Study. J Hypertens. 2006;24:2371–6.

  45. 45.

    Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002;106:2085–90.

  46. 46.

    Shoji T, Emoto M, Shinohara K, Kakiya R, Tsujimoto Y, Kishimoto H, et al. Diabetes mellitus, aortic stiffness, and cardiovascular mortality in end-stage renal disease. J Am Soc Nephrol JASN. 2001;12:2117–24.

  47. 47.

    Kumar A, Hung OY, Piccinelli M, Eshtehardi P, Corban MT, Sternheim D, et al. Low Coronary Wall Shear Stress Is Associated With Severe Endothelial Dysfunction in Patients With Nonobstructive Coronary Artery Disease. JACC Cardiovasc Interv. 2018;11:2072–80.

  48. 48.

    Mäki-Petäjä KM, Hall FC, Booth AD, Wallace SML, Yasmin null, Bearcroft PWP, et al. Rheumatoid arthritis is associated with increased aortic pulse-wave velocity, which is reduced by anti-tumor necrosis factor-alpha therapy. Circulation. 2006;114:1185–92.

  49. 49.

    Dzieża-Grudnik A, Sulicka J, Strach M, Siga O, Klimek E, Korkosz M, et al. Arterial stiffness is not increased in patients with short duration rheumatoid arthritis and ankylosing spondylitis. Blood Press. 2017;26:115–21.

  50. 50.

    Taverner D, Paredes S, Ferré R, Masana L, Castro A, Vallvé J-C. Assessment of arterial stiffness variables in patients with rheumatoid arthritis: A mediation analysis. Sci Rep. 2019;9:1–8.

  51. 51.

    Ambrosino P, Tasso M, Lupoli R, Di Minno A, Baldassarre D, Tremoli E, et al. Non-invasive assessment of arterial stiffness in patients with rheumatoid arthritis: a systematic review and meta-analysis of literature studies. Ann Med. 2015;47:457–67.

  52. 52.

    Bjarnegråd N, Bengtsson C, Brodszki J, Sturfelt G, Nived O, Länne T. Increased aortic pulse wave velocity in middle aged women with systemic lupus erythematosus. Lupus. 2006;15:644–50.

  53. 53.

    Sabio JM, Vargas-Hitos JA, Martínez-Bordonado J, Navarrete-Navarrete N, Díaz-Chamorro A, Olvera-Porcel C, et al. Cumulated organ damage is associated with arterial stiffness in women with systemic lupus erythematosus irrespective of renal function. Clin Exp Rheumatol. 2016;34:53–7.

  54. 54.

    Wang P, Mao Y-M, Zhao C-N, Liu L-N, Li X-M, Li X-P, et al. Increased Pulse Wave Velocity in Systemic Lupus Erythematosus: A Meta-Analysis. Angiology. 2018;69:228–35.

  55. 55.

    Duivenvoorden R, de Groot E, Elsen BM, Laméris JS, van der Geest RJ, Stroes ES, et al. In vivo quantification of carotid artery wall dimensions: 3.0-Tesla MRI versus B-mode ultrasound imaging. Circ Cardiovasc Imaging. 2009;2:235–42.

  56. 56.

    Den Ruijter HM, Peters SAE, Anderson TJ, Britton AR, Dekker JM, Eijkemans MJ, et al. Common carotid intima-media thickness measurements in cardiovascular risk prediction: a meta-analysis. JAMA. 2012;308:796–803.

  57. 57.

    Lorenz MW, Polak JF, Kavousi M, Mathiesen EB, Völzke H, Tuomainen T-P, et al. Carotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): a meta-analysis of individual participant data. Lancet Lond Engl. 2012;379:2053–62.

  58. 58.

    Södergren A, Karp K, Boman K, Eriksson C, Lundström E, Smedby T, et al. Atherosclerosis in early rheumatoid arthritis: very early endothelial activation and rapid progression of intima media thickness. Arthritis Res Ther. 2010;12:R158.

  59. 59.

    Bissell L-A, Erhayiem B, Fent G, Hensor EMA, Burska A, Donica H, et al. Carotid artery volumetric measures associate with clinical ten-year cardiovascular (CV) risk scores and individual traditional CV risk factors in rheumatoid arthritis; a carotid-MRI feasibility study. Arthritis Res Ther. 2018;20:266.

  60. 60.

    Henrot P, Foret J, Barnetche T, Lazaro E, Duffau P, Seneschal J, et al. Assessment of subclinical atherosclerosis in systemic lupus erythematosus: A systematic review and meta-analysis. Jt Bone Spine Rev Rhum. 2018;85:155–63.

  61. 61.

    Sharma SK, Rathi M, Sahoo S, Prakash M, Dhir V, Singh S. Assessment of premature atherosclerosis in systemic lupus erythematosus patients with and without nephritis. Lupus. 2016;25:525–31.

  62. 62.

    Bańska-Kisiel K, Haberka M, Bergler-Czop B, Brzezińska-Wcisło L, Okopień B, Gąsior Z. Carotid intima-media thickness in patients with mild or moderate psoriasis. Adv Dermatol Allergol Dermatol Alergol. 2016;33:286–9.

  63. 63.

    Atzeni F, Sarzi-Puttini P, Sitia S, Tomasoni L, Gianturco L, Battellino M, et al. Coronary flow reserve and asymmetric dimethylarginine levels: new measurements for identifying subclinical atherosclerosis in patients with psoriatic arthritis. J Rheumatol. 2011;38:1661–4.

  64. 64.

    Balci DD, Balci A, Karazincir S, Ucar E, Iyigun U, Yalcin F, et al. Increased carotid artery intima-media thickness and impaired endothelial function in psoriasis. J Eur Acad Dermatol Venereol JEADV. 2009;23:1–6.

  65. 65.

    Contessa C, Ramonda R, Lo Nigro A, Modesti V, Lorenzin M, Puato M, et al. Subclinical atherosclerosis in patients with psoriatic arthritis: a case-control study. Preliminary data. Reumatismo. 2009;61:298–305.

  66. 66.

    Kim SY, Yang HS, Lee YW, Choe YB, Ahn KJ. Evaluation of the Beta Stiffness Index and Carotid Intima-Media Thickness in Asian Patients With Psoriasis. Angiology. 2015;66:889–95.

  67. 67.

    Gonzalez-Cantero A, Gonzalez-Cantero J, Sanchez-Moya AI, Perez-Hortet C, Arias-Santiago S, Schoendorff-Ortega C, et al. Subclinical atherosclerosis in psoriasis. Usefulness of femoral artery ultrasound for the diagnosis, and analysis of its relationship with insulin resistance. PloS One. 2019;14:e0211808.

  68. 68.

    Tarkin JM, Joshi FR, Rudd JHF. PET imaging of inflammation in atherosclerosis. Nat Rev Cardiol. 2014;11:443–57.

  69. 69.

    Rudd JHF, Narula J, Strauss HW, Virmani R, Machac J, Klimas M, et al. Imaging atherosclerotic plaque inflammation by fluorodeoxyglucose with positron emission tomography: ready for prime time? J Am Coll Cardiol. 2010;55:2527–35.

  70. 70.

    Ogawa M, Nakamura S, Saito Y, Kosugi M, Magata Y. What can be seen by 18F-FDG PET in atherosclerosis imaging? The effect of foam cell formation on 18F-FDG uptake to macrophages in vitro. J Nucl Med Off Publ Soc Nucl Med. 2012;53:55–8.

  71. 71.

    Rudd JHF, Warburton EA, Fryer TD, Jones HA, Clark JC, Antoun N, et al. Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation. 2002;105:2708–11.

  72. 72.

    Duivenvoorden R, Mani V, Woodward M, Kallend D, Suchankova G, Fuster V, et al. Relationship of serum inflammatory biomarkers with plaque inflammation assessed by FDG PET/CT: the dal-PLAQUE study. JACC Cardiovasc Imaging. 2013;6:1087–94.

  73. 73.

    Figueroa AL, Abdelbaky A, Truong QA, Corsini E, MacNabb MH, Lavender ZR, 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.

  74. 74.

    Tawakol A, Fayad ZA, Mogg R, Alon A, Klimas MT, Dansky H, et al. Intensification of statin therapy results in a rapid reduction in atherosclerotic inflammation: results of a multicenter fluorodeoxyglucose-positron emission tomography/computed tomography feasibility study. J Am Coll Cardiol. 2013;62:909–17.

  75. 75.

    von Schulthess GK, Kuhn FP, Kaufmann P, Veit-Haibach P. Clinical positron emission tomography/magnetic resonance imaging applications. Semin Nucl Med. 2013;43:3–10.

  76. 76.

    Fernández-Friera L, Fuster V, López-Melgar B, Oliva B, Sánchez-González J, Macías A, et al. Vascular Inflammation in Subclinical Atherosclerosis Detected by Hybrid PET/MRI. J Am Coll Cardiol. 2019;73:1371–82.

  77. 77.

    Mehta NN, Yu Y, Saboury B, Foroughi N, Krishnamoorthy P, Raper A, et al. Systemic and vascular inflammation in patients with moderate to severe psoriasis as measured by [18F]-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT): a pilot study. Arch Dermatol. 2011;147:1031–9.

  78. 78.

    Mehta NN, Torigian DA, Gelfand JM, Saboury B, Alavi A. Quantification of atherosclerotic plaque activity and vascular inflammation using [18-F] fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). J Vis Exp JoVE. 2012:e3777.

  79. 79.

    Rose S, Sheth NH, Baker JF, Ogdie A, Raper A, Saboury B, et al. A comparison of vascular inflammation in psoriasis, rheumatoid arthritis, and healthy subjects by FDG-PET/CT: a pilot study. Am J Cardiovasc Dis. 2013;3:273–8.

  80. 80.

    Naik HB, Natarajan B, Stansky E, Ahlman MA, Teague H, Salahuddin T, et al. Severity of Psoriasis Associates With Aortic Vascular Inflammation Detected by FDG PET/CT and Neutrophil Activation in a Prospective Observational Study. Arterioscler Thromb Vasc Biol [Internet]. 2015 [cited 2018 Sep 14]; Available from: https://www.ahajournals.org/doi/10.1161/ATVBAHA.115.306460

  81. 81.

    Dey AK, Joshi AA, Chaturvedi A, Lerman JB, Aberra TM, Rodante JA, et al. Association Between Skin and Aortic Vascular Inflammation in Patients With Psoriasis: A Case-Cohort Study Using Positron Emission Tomography/Computed Tomography. JAMA Cardiol. 2017;2:1013–8.

  82. 82.

    Groenendyk JW, Shukla P, Dey AK, Elnabawi YA, Aksentijevich M, Choi H, et al. Association of aortic vascular uptake of 18FDG by PET/CT and aortic wall thickness by MRI in psoriasis: a prospective observational study. Eur J Nucl Med Mol Imaging [Internet]. 2019;46:2488–95. https://doi.org/10.1007/s00259-019-04454-w.

  83. 83.

    Gelfand JM, Shin DB, Alavi A, Torigian DA, Werner T, Papadopoulos M, et al. A Phase IV, Randomized, Double-Blind, Placebo-Controlled Crossover Study of the Effects of Ustekinumab on Vascular Inflammation in Psoriasis (the VIP-U trial). J Invest Dermatol [Internet]. 2019 [cited 2019 Aug 28]; Available from: http://www.sciencedirect.com/science/article/pii/S0022202X19325370

  84. 84.

    Mehta NN, Shin DB, Joshi AA, Dey AK, Armstrong AW, Duffin KC, et al. Effect of Two Psoriasis Treatments on Vascular Inflammation and Novel Inflammatory Cardiovascular Biomarkers: A Randomized Placebo-Controlled Trial. Circ Cardiovasc Imaging. 2018;11:e007394.

  85. 85.

    Vascular Inflammation in Psoriasis - Apremilast - Full Text View - ClinicalTrials.gov [Internet]. [cited 2019 Aug 28]. Available from: https://clinicaltrials.gov/ct2/show/NCT03082729

  86. 86.

    Study to Evaluate the Effect of Secukinumab Compared to Placebo on Aortic Vascular Inflammation in Subjects With Moderate to Severe Plaque Psoriasis - Study Results - ClinicalTrials.gov [Internet]. [cited 2019 Aug 28]. Available from: https://clinicaltrials.gov/ct2/show/results/NCT02690701

  87. 87.

    Skeoch S, Cristinacce PLH, Williams H, Pemberton P, Xu D, Sun J, et al. Imaging atherosclerosis in rheumatoid arthritis: evidence for increased prevalence, altered phenotype and a link between systemic and localised plaque inflammation. Sci Rep. 2017;7:827.

  88. 88.

    Mäki-Petäjä KM, Elkhawad M, Cheriyan J, Joshi FR, Ostör AJK, Hall FC, et al. Anti-tumor necrosis factor-α therapy reduces aortic inflammation and stiffness in patients with rheumatoid arthritis. Circulation. 2012;126:2473–80.

  89. 89.

    Geraldino-Pardilla L, Zartoshti A, Ozbek AB, Giles JT, Weinberg R, Kinkhabwala M, et al. Arterial Inflammation Detected With 18 F-Fluorodeoxyglucose-Positron Emission Tomography in Rheumatoid Arthritis. Arthritis Rheumatol Hoboken NJ. 2018;70:30–9.

  90. 90.

    Roivainen A, Hautaniemi S, Möttönen T, Nuutila P, Oikonen V, Parkkola R, et al. Correlation of 18F-FDG PET/CT assessments with disease activity and markers of inflammation in patients with early rheumatoid arthritis following the initiation of combination therapy with triple oral antirheumatic drugs. Eur J Nucl Med Mol Imaging. 2013;40:403–10.

  91. 91.

    Haavisto M, Saraste A, Pirilä L, Hannukainen JC, Kalliokoski KK, Kirjavainen A, et al. Influence of triple disease modifying anti-rheumatic drug therapy on carotid artery inflammation in drug-naive patients with recent onset of rheumatoid arthritis. Rheumatol Oxf Engl. 2016;55:1777–85.

  92. 92.

    Carlucci PM, Purmalek MM, Dey AK, Temesgen-Oyelakin Y, Sakhardande S, Joshi AA, et al. Neutrophil subsets and their gene signature associate with vascular inflammation and coronary atherosclerosis in lupus. JCI Insight. 2018;3.

  93. 93.

    Batty JA, Subba S, Luke P, Gigi LWC, Sinclair H, Kunadian V. Intracoronary Imaging in the Detection of Vulnerable Plaques. Curr Cardiol Rep. 2016;18:28.

  94. 94.

    Papadopoulou S-L, Neefjes LA, Schaap M, Li H-L, Capuano E, van der Giessen AG, et al. Detection and quantification of coronary atherosclerotic plaque by 64-slice multidetector CT: a systematic head-to- head comparison with intravascular ultrasound. Atherosclerosis. 2011;219:163–70.

  95. 95.

    Fischer C, Hulten E, Belur P, Smith R, Voros S, Villines TC. Coronary CT angiography versus intravascular ultrasound for estimation of coronary stenosis and atherosclerotic plaque burden: a meta- analysis. J Cardiovasc Comput Tomogr. 2013;7:256–66.

  96. 96.

    Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291:210–5.

  97. 97.

    Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–45.

  98. 98.

    Polonsky TS, McClelland RL, Jorgensen NW, Bild DE, Burke GL, Guerci AD, et al. Coronary Artery Calcium Score and Risk Classification for Coronary Heart Disease Prediction: The Multi-Ethnic Study of Atherosclerosis. JAMA J Am Med Assoc. 2010;303:1610–6.

  99. 99.

    Nasir K, Bittencourt MS, Blaha MJ, Blankstein R, Agatson AS, Rivera JJ, et al. Implications of Coronary Artery Calcium Testing Among Statin Candidates According to American College of Cardiology/American Heart Association Cholesterol Management Guidelines: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2015;66:1657–68.

  100. 100.

    Morteza N, Peter L, Erling F, Ward CS, Silvio L, John R, et al. From Vulnerable Plaque to Vulnerable Patient. Circulation. 2003;108:1664–72.

  101. 101.

    Motoyama S, Ito H, Sarai M, Kondo T, Kawai H, Nagahara Y, et al. Plaque Characterization by Coronary Computed Tomography Angiography and the Likelihood of Acute Coronary Events in Mid-Term Follow-Up. J Am Coll Cardiol. 2015;66:337–46.

  102. 102.

    Plank F, Friedrich G, Dichtl W, Klauser A, Jaschke W, Franz W-M, et al. The diagnostic and prognostic value of coronary CT angiography in asymptomatic high-risk patients: a cohort study. Open Heart. 2014;1:e000096.

  103. 103.

    Williams MC, Moss AJ, Dweck M, Adamson PD, Alam S, Hunter A, et al. Coronary Artery Plaque Characteristics Associated With Adverse Outcomes in the SCOT-HEART Study. J Am Coll Cardiol. 2019;73:291–301.

  104. 104.

    Kolossváry M, Karády J, Kikuchi Y, Ivanov A, Schlett CL, Lu MT, et al. Radiomics versus Visual and Histogram-based Assessment to Identify Atheromatous Lesions at Coronary CT Angiography: An Ex Vivo Study. Radiology. 2019;190407.

  105. 105.

    Sheahan M, Ma X, Paik D, Obuchowski NA, St Pierre S, Newman WP, et al. Atherosclerotic Plaque Tissue: Noninvasive Quantitative Assessment of Characteristics with Software-aided Measurements from Conventional CT Angiography. Radiology. 2018;286:622–31.

  106. 106.

    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.

  107. 107.

    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. The Lancet. 2018;392:929–39.

  108. 108.

    Kao AH, Wasko MCM, Krishnaswami S, Wagner J, Edmundowicz D, Shaw P, et al. C-reactive protein and coronary artery calcium in asymptomatic women with systemic lupus erythematosus or rheumatoid arthritis. Am J Cardiol. 2008;102:755–60.

  109. 109.

    Giles JT, Szklo M, Post W, Petri M, Blumenthal RS, Lam G, et al. Coronary arterial calcification in rheumatoid arthritis: comparison with the Multi-Ethnic Study of Atherosclerosis. Arthritis Res Ther. 2009;11:R36.

  110. 110.

    Karpouzas GA, Malpeso J, Choi T-Y, Li D, Munoz S, Budoff MJ. Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease. Ann Rheum Dis. 2014;73:1797–804.

  111. 111.

    Kiani AN, Vogel-Claussen J, Magder LS, Petri M. Noncalcified coronary plaque in systemic lupus erythematosus. J Rheumatol. 2010;37:579–84.

  112. 112.

    Khan A, Arbab-Zadeh A, Kiani AN, Magder LS, Petri M. Progression of Noncalcified and Calcified Coronary Plaque by CT Angiography in SLE. Rheumatol Int. 2017;37:59–65.

  113. 113.

    Lerman JB, Joshi AA, Chaturvedi A, Aberra TM, Dey AK, Rodante JA, et al. Coronary Plaque Characterization in Psoriasis Reveals High-Risk Features That Improve After Treatment in a Prospective Observational Study. Circulation. 2017;136:263–76.

  114. 114.

    Elnabawi YA, Dey AK, Goyal A, Groenendyk JW, Chung JH, Belur AD, et al. Coronary artery plaque characteristics and treatment with biologic therapy in severe psoriasis: results from a prospective observational study. Cardiovasc Res. 2019;115:721–8.

  115. 115.

    Elnabawi YA, Oikonomou EK, Dey AK, Mancio J, Rodante JA, Aksentijevich M, et al. Association of Biologic Therapy With Coronary Inflammation in Patients With Psoriasis as Assessed by Perivascular Fat Attenuation Index. JAMA Cardiol. 2019;

  116. 116.

    Shen J, Wong K-T, Cheng IT, Shang Q, Li EK, Wong P, et al. Increased prevalence of coronary plaque in patients with psoriatic arthritis without prior diagnosis of coronary artery disease. Ann Rheum Dis. 2017;76:1237–44.

  117. 117.

    Hecht HS, Narula J, Fearon WF. Fractional Flow Reserve and Coronary Computed Tomographic Angiography: A Review and Critical Analysis. Circ Res. 2016;119:300–16.

  118. 118.

    Koo B-K, Erglis A, Doh J-H, Daniels DV, Jegere S, Kim H-S, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol. 2011;58:1989–97.

  119. 119.

    Min JK, Leipsic J, Pencina MJ, Berman DS, Koo B-K, van Mieghem C, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA. 2012;308:1237–45.

  120. 120.

    Nørgaard BL, Leipsic J, Gaur S, Seneviratne S, Ko BS, Ito H, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol. 2014;63:1145–55.

  121. 121.

    Kruk M, Wardziak Ł, Demkow M, Pleban W, Pręgowski J, Dzielińska Z, et al. Workstation-Based Calculation of CTA-Based FFR for Intermediate Stenosis. JACC Cardiovasc Imaging. 2016;9:690–9.

Download references




Dr. Mehta is supported by a grant from the NIH, HL-06193-05

Author information

Correspondence to Nehal N. Mehta.

Ethics declarations

Conflict of Interest

NNM is a full-time US government employee and has served as a consultant for Amgen,Eli Lilly, and Leo Pharma receiving grants/other payments; as a principal investigator and/or investigator for AbbVie, Celgene, Janssen Pharmaceuticals, Inc, and Novartis receiving grants and/or research funding and as a principal investigator for the National Institute of Health receiving grants and/or research funding. HC and DEU are funded by the NIH Medical Research Scholars Program, a public-private partnership supported jointly by the NIH and generous contributions to the Foundation for the NIH from the Doris Duke Charitable Foundation (DDCF Grant #2014194), Genentech, Elsevier, and other private donors. All other authors have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Psoriatic Arthritis

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Choi, H., Uceda, D.E., Dey, A.K. et al. Application of Non-invasive Imaging in Inflammatory Disease Conditions to Evaluate Subclinical Coronary Artery Disease. Curr Rheumatol Rep 22, 1 (2020). https://doi.org/10.1007/s11926-019-0875-0

Download citation


  • Inflammation
  • Subclinical
  • Cardiovascular
  • Imaging