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18F-sodium fluoride uptake is a marker of active calcification and disease progression in patients with aortic stenosis

Author(s): M. R. Dweck, W. S. Jenkins, A. T. Vesey, M. A. Pringle, C. W. Chin, T. S. Malley, W. J. Cowie, V. Tsampasian, H. Richardson, A. Fletcher, W. A. Wallace, R. Pessotto, E. J. van Beek, N. A. Boon, J. H. Rudd, D. E. Newby

BACKGROUND: 18F-Sodium fluoride (18F-NaF) and 18F-fluorodeoxyglucose (18F-FDG) are promising novel biomarkers of disease activity in aortic stenosis. We compared 18F-NaF and 18F-FDG uptake with histological characterization of the aortic valve and assessed whether they predicted disease progression. METHODS AND RESULTS: Thirty patients with aortic stenosis underwent combined positron emission and computed tomography using 18F-NaF and 18F-FDG radiotracers. In 12 patients undergoing aortic valve replacement surgery (10 for each tracer), radiotracer uptake (mean tissue/ BACKGROUND: =0.65; P=0.04) and osteocalcin (r=0.68; P=0.03) immunohistochemistry. There was no significant correlation between 18F-FDG uptake and CD68 staining (r=-0.43; P=0.22). After 1 year, aortic valve calcification increased from 314 (193-540) to 365 (207-934) AU (P<0.01). Baseline 18F-NaF uptake correlated closely with the change in calcium score (r=0.66; P<0.01), and this improved further (r=0.75; P<0.01) when 18F-NaF uptake overlying computed tomography-defined macrocalcification was excluded. No significant correlation was noted between valvular 18F-FDG uptake and change in calcium score (r=-0.11; P=0.66). CONCLUSIONS: 18F-NaF uptake identifies active tissue calcification and predicts disease progression in patients with calcific aortic stenosis. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01358513.

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ISBN: 1942-0080 (Electronic) 1941-9651 (Linking)
Publication Year: 2014
Periodical: Circ Cardiovasc Imaging
Periodical Number: 2
Volume: 7
Pages: 371-8
Author Address: Centre for Cardiovascular Science.