UK: Thoracic aortic 18F-sodium fluoride activity in patients with established cardiovascular disease (CVD) is associated with the progression of atherosclerosis and future ischemic stroke, states a recent study in the journal JACC: Cardiovascular Imaging.
The study revealed that THE assessment of thoracic 18F-sodium fluoride positron emission tomography (PET) identifies localized areas of atherosclerotic disease activity that are directly associated with disease progression and downstream regional clinical atherothrombotic events.

Aortic atherosclerosis is known to be an important contributor to the risk of ischemic stroke. Identification of patients with high-risk aortic atheroma could boost preventative treatment strategies for future ischemic stroke. Considering this, Alexander J. Fletcher, University of Edinburgh, Edinburgh, United Kingdom, and colleagues aimed to investigate whether thoracic 18F-sodium fluoride positron emission tomography could improve the identification of patients at the highest risk of ischemic stroke in a post hoc observational cohort study.
For this purpose, the researchers quantified thoracic aortic and coronary 18F-sodium fluoride activity in 461 patients with stable cardiovascular disease undergoing PET combined with computed tomography (CT). Change in aortic and coronary CT calcium volume was used to assess the progression of atherosclerosis. The occurrence of ischemic stroke and myocardial infarction determined the clinical outcomes. The prognostic utility of 18F-sodium fluoride activity for predicting stroke was compared to clinical risk scores and CT calcium quantification using survival analysis and multivariable Cox regression.
Based on the study, the researchers found the following:
After 12.7 ± 2.7 months, progression of thoracic aortic calcium volume correlated with baseline thoracic aortic 18F-sodium fluoride activity (n = 140; r = 0.31).
In 461 patients, 23 (5%) patients experienced an ischemic stroke and 32 (7%) a myocardial infarction after 6.1 ± 2.3 years of follow-up.
High thoracic aortic 18F-sodium fluoride activity was strongly associated with ischemic stroke (HR: 10.3), but not myocardial infarction.
High coronary 18F-sodium fluoride activity was associated with myocardial infarction (HR: 4.8) but not ischemic stroke.
In a multivariable Cox regression model including imaging and clinical risk factors, thoracic aortic 18F-sodium fluoride activity was the only variable associated with ischemic stroke (HR: 8.19).
The researchers conclude, "thoracic aortic 18F-sodium fluoride activity is associated with the progression of atherosclerosis and future ischemic stroke in patients with CVD. However, the small number of stroke events means larger, adequately powered cohorts will be needed."
Reference
The study titled, "Thoracic Aortic 18F-Sodium Fluoride Activity and Ischemic Stroke in Patients With Established Cardiovascular Disease," was published in the journal JACC: Cardiovascular Imaging.
DOI: 10.1016/j.jcmg.2021.12.013
KEYWORDS: cardiovascular disease, PET, CT, ischemic stroke, Alexander J Fletcher, 18F-sodium fluoride activity, computed tomography, positron emission tomography, atherosclerotic disease, atherosclerosis