期刊
EUROPEAN HEART JOURNAL
卷 34, 期 21, 页码 1567-1574出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/eht034
关键词
Aortic stenosis; Calcification; Inflammation; Positron emission tomography; Atherosclerosis
资金
- British Heart Foundation [FS/10/026, CH/09/002]
- British Heart Foundation Centre of Research Excellence Award
- Higher Education Funding Council for England
- Cambridge National Institute for Health Research Biomedical Research Centre
- Scottish Imaging Network-a Platform of Scientific Excellence
- National Health Service Research Scotland (NRS) through National Health Service Lothian
- Academy of Medical Sciences (AMS) [AMS-SGCL1-Rudd] Funding Source: researchfish
- British Heart Foundation [PG/09/083/27667, FS/11/14/28692, FS/10/026/28209, FS/12/29/29463] Funding Source: researchfish
- Medical Research Council [G0701127] Funding Source: researchfish
- MRC [G0701127] Funding Source: UKRI
The pathophysiology of aortic stenosis shares many similarities with atherosclerosis and skeletal bone formation. Using non-invasive imaging, we compared aortic valve calcification and inflammation activity with that measured in atherosclerosis and bone. Positron emission and computed tomography was performed using 18F-sodium fluoride (18F-NaF, calcification) and 18F-fluorodeoxyglucose (18F-FDG, inflammation) in 101 patients with calcific aortic valve disease (81 aortic stenosis and 20 aortic sclerosis). Calcium scores and positron emission tomography tracer activity (tissue-to-background ratio; TBR) were measured in the aortic valve, coronary arteries, thoracic aorta, and bone. Over 90 of the cohort had coexistent calcific atheroma, yet correlations between calcium scores were weak or absent (valve vs. aorta r(2) 0.015, P 0.222; valve vs. coronaries r(2) 0.039, P 0.049) as were associations between calcium scores and bone mineral density (BMD vs. valve r(2) 0.000, P 0.766; vs. aorta r(2) 0.052, P 0.025; vs. coronaries r(2) 0.016, P 0.210). 18F-NaF activity in the valve was 28 higher than in the aorta (TBR: 2.66 0.84 vs. 2.11 0.31, respectively, P 0.001) and correlated more strongly with the severity of aortic stenosis (r(2) 0.419, P 0.001) than 18F-NaF activity outwith the valve (valve vs. aorta r(2) 0.167, P 0.001; valve vs. coronary arteries r(2) 0.174, P 0.001; valve vs. bone r(2) 0.001, P 0.806). In contrast, 18F-FDG activity was lower in the aortic valve than the aortic atheroma (TBR: 1.56 0.21 vs. 1.81 0.24, respectively, P 0.001) and more closely associated with uptake outwith the valve (valve vs. aorta r(2) 0.327, P 0.001). In patients with aortic stenosis, disease activity appears to be determined by local calcific processes within the valve that are distinct from atherosclerosis and skeletal bone metabolism. Trial Registration: ClinicalTrials.gov number: NCT01358513.
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