Positron emission tomography (PET) with F sodium fluoride (F-NaF) allows for the assessment of microcalcification activity (MA) in a wide variety of cardiovascular conditions, including atherosclerosis. In coronary artery disease, this tracer correlates with progressive disease and allows for the prediction of atherosclerosis progression.
Unlike PETs, computed tomography (CT) allows for the evaluation of an already established calcium score (CS), although serial and comparative imaging could indicate disease stability or progression.
This paper, recently published in JACC, analyzed coronary microcalcification activity (CMA) using F-NaF PET in a group of patients with coronary artery disease and two prior CT-evaluated calcium scores separated by at least a year.
Out of the 293 participants, 48 underwent myocardial revascularization surgery between 1.4 and 10.4 years before (mean: 2.7 years); these patients were compared with a group of 48 patients with coronary artery disease without MRS with similar clinical and anatomical characteristics (control group).
One of the most striking findings is that native coronary arteries with grafts had significantly higher CMA values (2.1 [interquartile ratio-IQR: 0.4-7.5] vs. 0.6 [IQR: 0-2.7], p < 0.001) than the control group. This effect was mostly confined to the proximal portion of the vessels that received anastomoses (CMA 2.0 proximal vs. 0.2 distal to anastomosis).
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As for TC, CS progressed 3x faster within the proximal segment of vessels that received anastomosis than in the same segments of the group with which they were compared (118 vs. 69 U. Agatston p = 0.01). This difference was not observed in the distal segments of both groups.
Out of the 154 analyzed grafts, only 37 (24%) showed evidence of vasculopathy in CT y 20 were occluded (13%). Only 8 vein grafts showed F-NaF uptake activity (microcalcification activity), suggesting that microcalcification may not be the dominant mechanism of vein graft degeneration, although this observation warrants further research.
Conclusions
The authors conclude that coronary arteries that have undergone bypass have greater activity and more disease progression than arteries that have not. That seems to be independent from baseline atherosclerotic burden.
This greater progression is much more intense in the portion of the native vessel proximal to the anastomosis.
Dr. José Álvarez
Director of solaci.org Website
Original Title: Bypass Grafting and Native Coronary Artery Disease Activity.
Reference: Jacek Kwiecinski, MD, PHD,a,b,c,d Evangelos Tzolos, MD,a,b,c,e Alexander J. Fletcher, MD, et al. J Am Coll Cardiol Img 2022 (in press).
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