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Cardiac microcalcification burden: Global assessment in high cardiovascular risk subjects with Na[18F]F PET-CT

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Fluorine-18 sodium fluoride (Na[18F]F) atherosclerotic plaque uptake in positron emission tomography with computed tomography (PET-CT) identifies active microcalcification. We aim to evaluate global cardiac microcalcification activity with Na[18F]F, as a measure of unstable microcalcification burden, in high cardiovascular (CV) risk patients.

Methods and Results

Thirty-four high CV risk individuals without previous CV events were scanned with Na[18F]F PET-CT. Cardiac Na[18F]F uptake was assessed through the global molecular calcium score (GMCS), which was calculated by summing the product of the mean standardized uptake value times the area of the cardiac regions of interest times the slice thickness for all cardiac transaxial slices, divided by the total number of slices. Mean age is 63.5 ± 7.8 years and 62% male. Median GMCS is 320.9 (240.8-402.8). Individuals with more than five CV risk factors (50%) have increased GMCS [356.7 (321.0-409.6) vs. 261.1 (225.6-342.1), P = 0.01], which is positively correlated with predicted fatal CV risk by SCORE (rs = 0.32, P = 0.04). There is a positive correlation between GMCS and weight (rs = 0.61), body mass index (rs = 0.66), abdominal perimeter (rs = 0.74), thoracic fat volume (rs = 0.47), and epicardial adipose tissue (rs = 0.41), all with P ≤ 0.01. There is no correlation between GMCS and coronary calcium score nor coronary artery wall Na[18F]F uptake.

Conclusions

In a high CV risk group, the global cardiac microcalcification burden is related to CV risk factors, metabolic syndrome variables and cardiac fat. Cardiac GMCS is a promising risk stratification tool, combining a straightforward and objective methodology with a comprehensive analysis of both coronary and valvular microcalcification.

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Abbreviations

CAC:

Coronary artery calcium score

CAD:

Coronary artery disease

CT:

Computerized tomography

CV:

Cardiovascular

GMCS:

Global molecular calcification score

Na[18F]F:

Fluorine-18 sodium fluoride

PET:

Positron emission tomography

ROI:

Regions of interest

SUV:

Standard uptake value

TBR:

Target-to-background ratio

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Author information

Author notes

  1. João Borges-Rosa and Manuel Oliveira-Santos have equally contributed to this work and are joint first authors.

Authors and Affiliations

  1. Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal

    João Borges-Rosa MD, Manuel Oliveira-Santos MD, Lino Gonçalves MD, PhD & Maria João Ferreira MD, PhD

  2. Institute of Nuclear Sciences, Applied to Health - Faculdade de Medicina da Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal

    Manuel Oliveira-Santos MD, Rodolfo Silva MD, Antero Abrunhosa PhD, Miguel Castelo-Branco MD, PhD & Maria João Ferreira MD, PhD

  3. Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504, Coimbra, Portugal

    Manuel Oliveira-Santos MD, Rodolfo Silva MD, Antero Abrunhosa PhD, Miguel Castelo-Branco MD, PhD, Lino Gonçalves MD, PhD & Maria João Ferreira MD, PhD

  4. Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal

    Manuel Oliveira-Santos MD, Rodolfo Silva MD, Antero Abrunhosa PhD, Miguel Castelo-Branco MD, PhD & Maria João Ferreira MD, PhD

  5. Coimbra Institute for Clinical and Biomedical Research (iCBR), Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal

    Lino Gonçalves MD, PhD

  6. Radiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal

    Nuno Pereira da Silva MD

Authors
  1. João Borges-Rosa MD
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  2. Manuel Oliveira-Santos MD
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  3. Rodolfo Silva MD
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  4. Nuno Pereira da Silva MD
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  5. Antero Abrunhosa PhD
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  6. Miguel Castelo-Branco MD, PhD
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  7. Lino Gonçalves MD, PhD
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  8. Maria João Ferreira MD, PhD
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Corresponding author

Correspondence to João Borges-Rosa MD.

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Funding

Institute of Nuclear Sciences Applied to Health (ICNAS) - Faculty of Medicine of the University of Coimbra. ROPPET-NAF trial (ClinicalTrials.gov Identifier: NCT03233243) is being conducted with the support of AstraZeneca, Produtos Farmacêuticos Lda

Disclosures

João Borges-Rosa, Manuel Oliveira-Santos, Rodolfo Silva, Nuno Pereira da Silva, Antero Abrunhosa, Miguel Castelo-Branco, Lino Gonçalves, and Maria João Ferreira have no conflict of interest to declare. This study was funded by Institute of Nuclear Sciences Applied to Health (ICNAS) - Faculty of Medicine of the University of Coimbra and with the support of AstraZeneca, Produtos Farmacêuticos Lda.

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Borges-Rosa, J., Oliveira-Santos, M., Silva, R. et al. Cardiac microcalcification burden: Global assessment in high cardiovascular risk subjects with Na[18F]F PET-CT. J. Nucl. Cardiol. 29, 1846–1854 (2022). https://doi.org/10.1007/s12350-021-02600-2

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