Detection of coronary inflammation

Abstract

We read with great interest Evangelos K Oikonomou and colleagues' Article1Oikonomou EK Marwan M Desai MY et al.Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data.Lancet. 2018; 392: 929-939Summary Full Text Full Text PDF PubMed Scopus (361) Google Scholar about the importance of the perivascular fat attenuation index in detection of coronary inflammation as assessed by cardiac CT. The authors concluded that the perivascular fat attenuation index provides a quantitative measure of coronary inflammation and is potentially superior to other imaging techniques used for this purpose. We wish to point out that gross structural changes visualised by conventional radiological techniques, including CT and MRI, are due to the late and advanced stages of the disease, when the process is irreversible and cannot be successfully treated with non-invasive interventions.2Alavi A Werner TJ Hoilund-Carlsen PF PET-based imaging to detect and characterize cardiovascular disorders: unavoidable path for the foreseeable future.J Nucl Cardiol. 2018; 25: 203-207Crossref PubMed Scopus (13) Google Scholar Therefore, imaging methods that provide information about disease activity at the molecular and cellular levels at the early stages of many disorders (figure), including atherosclerotic plaques in the coronary and other arteries, are urgently needed. We wish to emphasise the importance of PET imaging to detect inflammation and molecular calcification in this common and potentially fatal disease. Data clearly show the role for imaging with 18F-fluorodeoxyglucose in detection of inflammation in plaques and 18F-NaF in the detection of molecular calcification.3McKenney-Drake ML Moghbel MC Paydary K et al.18F-NaF and 18F-FDG as molecular probes in the evaluation of atherosclerosis.Eur J Nucl Med Mol Imaging. 2018; 45: 2190-2200Crossref PubMed Scopus (78) Google Scholar High sensitivity and specificity have been reported for these techniques, and, thus, they have a crucial role in managing this very common human disease.3McKenney-Drake ML Moghbel MC Paydary K et al.18F-NaF and 18F-FDG as molecular probes in the evaluation of atherosclerosis.Eur J Nucl Med Mol Imaging. 2018; 45: 2190-2200Crossref PubMed Scopus (78) Google Scholar, 4Moghbel M Al-Zaghal A Werner TJ et al.The role of PET in evaluating atherosclerosis: a critical review.Semin Nucl Med. 2018; 48: 488-497Crossref PubMed Scopus (40) Google Scholar Furthermore, the high sensitivity of these approaches will allow assessment of response to therapeutic interventions shortly after initiation, which might not be feasible with conventional imaging techniques.5Dey A Playford M Joshi A et al.Improvement in large density HDL particle number by NMR is associated with improvement in vascular inflammation by 18-FDG PET/CT at one-year in psoriasis.J Am Coll Cardiol. 2018; 71 (abstr).: A1688Crossref Google Scholar Structural changes are well established to remain unchanged for an extended period of time and, therefore, might not allow timely adoption of the most effective therapeutic intervention. We strongly believe that future imaging techniques should include both PET and structural imaging methods, such as CT and MRI, in combination for optimal management of many disorders, including atherosclerosis. We declare no competing interests. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome dataThe perivascular FAI enhances cardiac risk prediction and restratification over and above current state-of-the-art assessment in coronary CTA by providing a quantitative measure of coronary inflammation. High perivascular FAI values (cutoff ≥–70·1 HU) are an indicator of increased cardiac mortality and, therefore, could guide early targeted primary prevention and intensive secondary prevention in patients. Full-Text PDF Open AccessDetection of coronary inflammationBy use of coronary CT angiography in two large real-life prospective cohorts from completely different populations, Evangelos K Oikonomou and colleagues1 validated the prognostic value of a non-invasive marker of coronary inflammation, the perivascular fat attenuation index.2 In this study, a fat attenuation index higher than −70·1 Hounsfield units was identified as a strong predictor of all-cause and cardiac mortality, independent of demographics, epicardial fat volume, high-risk plaque features, and the extent of atherosclerosis. Full-Text PDF Detection of coronary inflammation – Authors' replyWe thank Abass Alavi and colleagues and Gaston A Rodriguez-Granillo and Patricia Carrascosa for their comments on the CRISP CT study.1 Full-Text PDF