¹⁸ F-Sodium fluoride uptake is associated with severity of atherosclerotic stenosis in stable ischemic heart disease

Background: Increased uptake of ¹⁸F-Sodium fluoride (¹⁸F-NaF) PET has potential to identify atherosclerotic plaques that are vulnerable to rupture. Whether ¹⁸F-NaF PET can evaluate the significance of atherosclerotic plaque in patients with stable coronary artery disease is less clear. We evaluated ¹⁸F-NaF PET uptake in coronary arteries in patients without acute coronary artery syndrome to determine the association of ¹⁸F-NaF signal uptake with severity of coronary stenosis.

Methods and results: We retrospectively identified 114 patients who received both regadenoson stress ⁸²Rb myocardial perfusion PET and ¹⁸F-NaF PET study with an average interval of 5 months. Out of this cohort, forty-one patients underwent invasive coronary angiography. In a patient-based analysis, patients with ischemic regadenoson stress ⁸²Rb PET had significantly higher coronary ¹⁸F-NaF uptake than patients with normal myocardial perfusion (P < .01). Among the 41 patients who underwent coronary angiography, per-vessel ¹⁸F-NaF uptake in both obstructive and nonobstructive coronary arteries was significantly higher than in normal coronary arteries (P < .05) regardless of the severity of coronary calcification. There was poor correlation between calcification and ¹⁸F-NaF uptake in coronary arteries (r = 0.41) CONCLUSION: Coronary arterial ¹⁸F-NaF uptake is associated with coronary stenosis severity in patients with stable coronary artery disease. ¹⁸F-NaF PET studies may be useful for characterizing coronary atherosclerotic plaques.

Keywords: Atherosclerosis; Molecular imaging; Myocardial ischemia and infarction; PET.