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Association of aortic vascular uptake of 18FDG by PET/CT and aortic wall thickness by MRI in psoriasis: a prospective observational study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Background

The contribution of inflammation to the incidence of cardiovascular disease (CVD) has been increasingly recognized in recent years. We investigated the relationship of aortic vascular uptake of 18F-FDG by PET/CT and aortic wall thickness (AWT) by MRI in psoriasis, a chronic inflammatory disease with increased incidence of CVD. One hundred sixty-five patients with plaque psoriasis participated in an ongoing longitudinal cohort study. Subclinical atherosclerosis was assessed as aortic uptake of 18F-FDG by PET/CT reported as target-to-background ratio (TBR) and AWT by MRI reported as maximal thickness.

Results

Patients with psoriasis were middle aged, predominantly male, and had mild CV risk by traditional risk factors. Psoriasis severity as measured by PASI score was a notable determinant of AWT (ρ = 0.20, p = 0.01). Moreover, aortic vascular uptake of 18F-FDG associated with AWT by MRI at baseline in unadjusted analysis (β = 0.27 p = 0.001) and following adjustment for traditional cardiovascular risk factors, waist-to-hip ratio, and statin use (β = 0.21 p = 0.01). Finally, following 1 year of psoriasis treatment, a decrease in aortic vascular uptake of 18F-FDG was associated with a reduction in AWT in fully adjusted models (β = 0.33, p = 0.02).

Conclusion

In conclusion, we demonstrate that psoriasis severity and aortic vascular uptake of 18F-FDG in the aorta were associated with AWT. Following treatment of psoriasis, a decrease in aortic vascular uptake of 18F-FDG was associated with a reduction in AWT at 1 year. These findings suggest that aortic vascular uptake of 18F-FDG is associated with early evidence of vascular disease assessed by aortic wall thickness. Prospective studies in larger populations including other inflammatory diseases are warranted.

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Abbreviations

AWT:

Aortic wall thickness

MRI:

Magnetic resonance imaging

18FDG PET/CT:

18Fluorodeoxyglucose positron emission tomography computed tomography

TBR:

Target-to-background ratio

PASI:

Psoriasis area severity index

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Acknowledgments

We would like to acknowledge and thank NIH Clinical Center outpatient clinic-7 nurses for their invaluable contribution to the process of patient recruitment.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Funding

This study was supported by the National Heart, Lung and Blood Institute (NHLBI) Intramural Research Program (HL006193-05). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140, Bethesda, MD, 20892, USA

    Jacob W. Groenendyk, Parag Shukla, Amit K. Dey, Youssef A. Elnabawi, Milena Aksentijevich, Harry Choi, Leonard D. Genovese, Charlotte L. Harrington, Balaji Natarajan, Aditya Goyal, Aarthi S. Reddy, Justin Rodante, Mohammad Tarek Kabbany, Ahmed Sadek, Mina Al Najafi, Martin P. Playford, Aditya A. Joshi & Nehal N. Mehta

  2. National Institutes of Health Clinical Center, 10 Center Drive, Clinical Research Center, Bethesda, MD, 20892, USA

    Mark A. Ahlman

  3. University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Joel M. Gelfand

  4. University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA

    David A. Bluemke

Authors
  1. Jacob W. Groenendyk
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  2. Parag Shukla
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  3. Amit K. Dey
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  4. Youssef A. Elnabawi
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  5. Milena Aksentijevich
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  6. Harry Choi
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  7. Leonard D. Genovese
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  8. Charlotte L. Harrington
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  9. Balaji Natarajan
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  10. Aditya Goyal
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  11. Aarthi S. Reddy
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  13. Mohammad Tarek Kabbany
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  15. Mina Al Najafi
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  21. Nehal N. Mehta
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Contributions

1. Drs. Groenendyk, Dey, and Mehta had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

2. Concept and design: Dr. Mehta conceived the study concept and the study design was by Drs. Mehta and Gelfand.

3. Acquisition, analysis, or interpretation of data: Drs. Groenendyk, Dey, and Mehta acquired and analyzed the data.

4. Drafting of the manuscript: Drs. Groenendyk, Dey, and Mehta drafted the manuscript.

5. Critical revision of the manuscript for important intellectual content: All co-authors provided critical revisions of the manuscript.

6. Administrative, technical, or material support: Dr. Mehta provided technical guidance to Drs. Groenendyk and Dey during the study.

Corresponding author

Correspondence to Nehal N. Mehta.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the National Institutes of Health Institutional Review Board. From January 1, 2013, to July 1, 2018, 291 patients with psoriasis were recruited consecutively and underwent a baseline physical exam and laboratory assessment. Informed consent was obtained from each patient prior to initiation of the study.

Consent for publication

Not applicable.

Competing interests

  1. 1.

    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.

  2. 2.

    JMG was supported by an NIAMS grant (K24-AR-064310); Dr. Gelfand served as a consultant for BMS, Boehringer Ingelheim, GSK, Janssen Biologics, Menlo Therapeutics, Novartis Corp, Regeneron, Dr. Reddy’s labs, UCB (DSMB), Sanofi and Pfizer Inc., receiving honoraria; and receives research grants (to the Trustees of the University of Pennsylvania) from Abbvie, Janssen, Novartis Corp, Sanofi, Celgene, Ortho Dermatologics, and Pfizer Inc.; and received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly and Ortho Dermatologics.

  3. 3.

    JWG is 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.

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Groenendyk, J.W., Shukla, P., Dey, A.K. 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 46, 2488–2495 (2019). https://doi.org/10.1007/s00259-019-04454-w

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