Temporal Changes in Coronary<sup>18</sup>F-Fluoride Plaque Uptake in Patients with Coronary Atherosclerosis
Marwa Daghem, Philip D Adamson, Kang-Ling Wang, Mhairi Doris, Rong Bing, Edwin J.R. van Beek, Laura Forsyth, Michelle C. Williams, Evangelos Tzolos, Damini Dey, Piotr J. Slomka, Marc R. Dweck, David E. Newby, Alastair J. Moss
Abstract
Coronary <sup>18</sup>F-sodium fluoride (<sup>18</sup>F-fluoride) uptake is a marker of both atherosclerotic disease activity and disease progression. It is currently unknown whether there are rapid temporal changes in coronary <sup>18</sup>F-fluoride uptake and whether these are more marked in those with clinically unstable coronary artery disease. This study aimed to determine the natural history of coronary <sup>18</sup>F-fluoride uptake over 12 mo in patients with either advanced chronic coronary artery disease or a recent myocardial infarction. <b>Methods:</b> Patients with established multivessel coronary artery disease and either chronic disease or a recent acute myocardial infarction underwent coronary <sup>18</sup>F-fluoride PET and CT angiography, which was repeated at 3, 6, or 12 mo. Coronary <sup>18</sup>F-fluoride uptake was assessed in each vessel by measuring the coronary microcalcification activity (CMA). Coronary calcification was quantified by measuring calcium score, mass, and volume. <b>Results:</b> Fifty-nine patients had chronic coronary artery disease (median age, 68 y; 93% male), and 52 patients had a recent myocardial infarction (median age, 65 y; 83% male). Reflecting the greater burden of coronary artery disease, baseline CMA values were higher in those with chronic coronary artery disease. Coronary <sup>18</sup>F-fluoride uptake (CMA > 0) was associated with higher baseline calcium scores (294 Agatston units [AU] [interquartile range, 116–483 AU] vs. 72 AU [interquartile range, 8–222 AU]; <i>P</i> < 0.001) and more rapid progression of coronary calcification scores (39 AU [interquartile range, 10–82 AU] vs. 12 AU [interquartile range, 1–36 AU]; <i>P</i> < 0.001) than was the absence of uptake (CMA = 0). Coronary <sup>18</sup>F-fluoride uptake did not markedly alter over the course of 3, 6, or 12 mo in patients with either chronic coronary artery disease or a recent myocardial infarction. <b>Conclusion:</b> Coronary <sup>18</sup>F-fluoride uptake is associated with the severity and progression of coronary artery disease but does not undergo a rapid dynamic change in patients with chronic or unstable coronary artery disease. This finding suggests that coronary <sup>18</sup>F-fluoride uptake is a temporally stable marker of established and progressive disease.