Vascular biomechanics and molecular disease activity in the thoracic aorta: a novel imaging method

Minderhoud, S. C.S. et al. (2022) Vascular biomechanics and molecular disease activity in the thoracic aorta: a novel imaging method. European Heart Journal: Cardiovascular Imaging, 23(12), pp. 1698-1707. (doi: 10.1093/ehjci/jeac090) (PMID:35666823)

Abstract

Aims The influence haemodynamics have on vessel wall pathobiology in aortic disease is incomplete. This aim of this study was to develop a repeatable method for assessing the relationship between aortic wall shear stress (WSS) and disease activity by fusing 4D flow cardiovascular magnetic resonance (CMR) with hybrid positron emission tomography (PET). Methods and results As part of an ongoing clinical trial, patients with bicuspid aortic valve (BAV) were prospectively imaged with both 18F-sodium fluoride (18F-NaF) PET, a marker of calcification activity, and 4D flow CMR. We developed novel software allowing accurate 3D co-registration and high-resolution comparison of aortic peak systolic WSS and 18F-NaF PET uptake (maximum tissue-to-background ratio). Intra-observer repeatability of both measurements was determined using Bland–Altman plots and intra-class correlation coefficients (ICCs). The relationship between localized WSS and 18F-NaF uptake was analysed using linear mixed-effect models. Twenty-three patients with BAV (median age 50 [44–55] years, 22% female) were included. Intra-observer repeatability for WSS (ICC = 0.92) and 18F-NaF (ICC = 0.91) measurements obtained within 1.4 ± 0.6 cm2 regions of interest was excellent. On multivariable analysis, 18F-NaF PET uptake was independently and negatively associated with WSS as well as diastolic blood pressure (both P < 0.05), adjusted for age. Conclusion Fused assessment of WSS and 18F-NaF PET uptake is feasible and repeatable, demonstrating a clear association between these two factors. This high spatial resolution approach has major potential to advance our understanding of the relationship between vascular haemodynamics and disease activity.

• Item Type: Articles
• Additional Information: This study was supported by the Thorax Foundation, British Heart Foundation and Siemens. M.R.D. is supported by the British Heart Foundation (FS/SCRF/21/32010) and is the recipient of the Sir Jules Thorn Award for Biomedical Research 2015 (15/JTA). D.E.N. is supported by the British Heart Foundation (FS/19/15/34155, CH/09/002, RG/16/10/32375, RE/18/5/34216) and is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA).
• Keywords: Cardiology and Cardiovascular Medicine, Radiology, Nuclear Medicine and imaging, General Medicine
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Fletcher, Dr Alexander
• Authors: Minderhoud, S. C.S., Fletcher, A. J., MacNaught, G., Cadet, S., Korteland, S.-A., Kardys, I., Rizopoulos, D., Slomka, P., Newby, D. E., Roos-Hesselink, J. W., Walker, N. L., Semple, S., Hirsch, A., Dweck, M. R., and Wentzel, J. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: European Heart Journal: Cardiovascular Imaging
• Publisher: Oxford University Press
• ISSN: 2047-2404
• ISSN (Online): 2047-2412
• Published Online: 06 June 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in European Heart Journal: Cardiovascular Imaging 23(12): 1698-1707
• Publisher Policy: Reproduced under a Creative Commons licence