Common carotid artery molecular calcification assessed by 18F-NaF PET/CT is associated with increased cardiovascular disease risk: Results from the CAMONA study

34 Background: The pathophysiologic process involved in the development of atherosclerotic plaque includes inflammation, necrosis and mineralization of the arterial wall. 18F-sodium fluoride (NaF) PET/CT has been recently proposed to detect and quantify cardiovascular molecular calcification. However, the correlation with common cardiovascular risk factors has not been widely investigated. Objectives: We sought to investigate the relationship between molecular arterial mineral deposition in the common carotid artery assessed by NaF PET/CT and cardiovascular risk factors. Methods: Out of 140 subjects a total of 128 patients in whom carotid artery could be segmented (mean age 48±14 years, 51% males) from the Cardiovascular Molecular Calcification Assessed by 18F-NaF PET/CT (CAMONA) study were included in the analysis. All patients underwent hybrid PET/CT imaging 90-min after 18F-NaF administration. Tracer uptake in the common carotid arteries was quantitatively assessed by drawing regions of interest comprising the whole artery and measuring the blood-pool-corrected maximum and mean standardized uptake values (SUVmax and SUVmean, respectively) on each axial slice. Finally, average SUVmax and SUVmean were calculated over all slices and were compared with cardiovascular risk factors and with 10-year risk of cardiovascular events assessed by the Framingham model. Results: 18F-NaF uptake was significantly correlated with age, arterial hypertension, hypercholesterolemia, chronic kidney disease and body mass index, while an inverse correlation was observed with level of physical activity (Table 1). Moreover, a linear relationship was observed between 18F-NaF uptake and 10-year estimated risk of cardiovascular events (β=0.008; p=0.015 and β=0.011; p=0.008 for SUVmean and SUVmax, respectively). In particular, value of SUVmean 蠅0.94 (AUC 0.697; p=0.020) and a value of SUVmax 蠅1.14 (AUC 0.719; p=0.010) were able to identify patients at high risk of cardiovascular events with a Sensitivity of 54% and 77% and a Specificity of 82% and 68% for SUVmean and SUVmax, respectively. Conclusion: Carotid 18F-NaF uptake correlates with common cardiovascular risk factors and is more frequent in patients with high risk profile. Therefore, 18F-NaF PET/CT can provide a valuable tool to for predicting cardiovascular events.