Author + information
- Received November 14, 2018
- Revision received December 13, 2018
- Accepted December 14, 2018
- Published online March 25, 2019.
- Leticia Fernández-Friera, MD, PhDa,b,c,d,
- Valentín Fuster, MD, PhDa,e,∗ (, )@CNIC_CARDIO@MountSinaiNYC,
- Beatriz López-Melgar, MD, PhDa,b,d,
- Belén Oliva, MSca,
- Javier Sánchez-González, PhDa,f,
- Angel Macías, RTa,
- Braulio Pérez-Asenjo, BTP, RTa,
- Daniel Zamudio, MDa,
- Juan C. Alonso-Farto, MD, PhDa,g,
- Samuel España, PhDa,
- José Mendiguren, MDh,
- Héctor Bueno, MD, PhDa,i,j,
- Jose M. García-Ruiz, MDa,c,k,
- Borja Ibañez, MD, PhDa,c,l,
- Antonio Fernández-Ortiz, MD, PhDa,c,m and
- Javier Sanz, MDa,e
- aCentro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- bHospital Universitario HM Montepríncipe-CIEC, Madrid, Spain
- cCIBERV, Madrid, Spain
- dUniversidad CEU San Pablo, Madrid, Spain
- eIcahn School of Medicine at Mount Sinai, New York, New York
- fPhilips Healthcare, Iberia, Spain
- gHospital General Universitario Gregorio Marañón, Madrid, Spain
- hBanco de Santander, Madrid, Spain
- iHospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- jFacultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- kHospital Universitario de Cabueñes Gijón, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
- lIIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
- mHospital Clínico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
- ↵∗Address for correspondence:
Dr. Valentin Fuster, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3. 28029 Madrid, Spain.
Background Atherosclerosis is a chronic inflammatory disease, but data on arterial inflammation at early stages is limited.
Objectives The purpose of this study was to characterize vascular inflammation by hybrid 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI).
Methods Carotid, aortic, and ilio-femoral 18F-FDG PET/MRI was performed in 755 individuals (age 40 to 54 years; 83.7% men) with known plaques detected by 2-/3-dimensional vascular ultrasound and/or coronary calcification in the PESA (Progression of Early Subclinical Atherosclerosis) study. The authors evaluated the presence, distribution, and number of arterial inflammatory foci (increased 18F-FDG uptake) and plaques with or without inflammation (coincident 18F-FDG uptake).
Results Arterial inflammation was present in 48.2% of individuals (24.4% femorals, 19.3% aorta, 15.8% carotids, and 9.3% iliacs) and plaques in 90.1% (73.9% femorals, 55.8% iliacs, and 53.1% carotids). 18F-FDG arterial uptakes and plaques significantly increased with cardiovascular risk factors (p < 0.01). Coincident 18F-FDG uptakes were present in 287 of 2,605 (11%) plaques, and most uptakes were detected in plaque-free arterial segments (459 of 746; 61.5%). Plaque burden, defined by plaque presence, number, and volume, was significantly higher in individuals with arterial inflammation than in those without (p < 0.01). The number of plaques and 18F-FDG uptakes showed a positive albeit weak correlation (r = 0.25; p < 0.001).
Conclusions Arterial inflammation is highly prevalent in middle-aged individuals with known subclinical atherosclerosis. Large-scale multiterritorial PET/MRI allows characterization of atherosclerosis-related arterial inflammation and demonstrates 18F-FDG uptake in plaque-free arterial segments and, less frequently, within plaques. These findings suggest an arterial inflammatory state at early stages of atherosclerosis. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318)
The PESA study is cofunded equally by the Centro Nacional de Investigaciones Cardiovasculares (CNIC) and Banco Santander. The study also receives funding from the Instituto de Salud Carlos III (PI15/02019) and the European Regional Development Fund (ERDF) “A way to make Europe.” The CNIC is supported by the Ministerio de Ciencia, Innovación y Universidades, and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505). Dr. Sanchez-González is an employee of Philips Healthcare. Dr. Bueno has received research funding from the Instituto de Salud Carlos III, Spain (PIE16/00021 & PI17/01799), AstraZeneca, Bristol-Myers Squibb, Janssen, and Novartis; has received consulting fees from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, and Novartis; and has received speaking fees or support for attending scientific meetings from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, Novartis, and MEDSCAPE-the heart.org. All other authors have reported that they have no relationships relevant to the content of this paper to disclose. Ron Blankstein, MD, served as Guest Editor for this paper.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received November 14, 2018.
- Revision received December 13, 2018.
- Accepted December 14, 2018.
- 2019 American College of Cardiology Foundation
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