Bypass Grafting and Native Coronary Artery Disease Activity

Jacek Kwiecinski; Evangelos Tzolos; Alexander J  Fletcher; Jennifer  Nash; Mohammed N Meah; Sebastien Cadet; Philip D Adamson; Kajetan  Grodecki; Nikhil Joshi; Michelle C Williams; Edwin J R  van Beek; Chi  Lai; Adriana A S Tavares; Mark G. MacAskill; Damini Dey; Andrew H Baker; Jonathon Leipsic; Daniel S. Berman; Stephanie L Sellers; David E Newby; Marc R Dweck; Piotr J Slomka

doi:10.1016/j.jcmg.2021.11.030

Bypass Grafting and Native Coronary Artery Disease Activity

Jacek Kwiecinski, Evangelos Tzolos, Alexander J Fletcher , Jennifer Nash, Mohammed N Meah, Sebastien Cadet, Philip D Adamson, Kajetan Grodecki, Nikhil Joshi, Michelle C Williams, Edwin J R van Beek, Chi Lai , Adriana A S Tavares, Mark G. MacAskill, Damini Dey, Andrew H Baker, Jonathon Leipsic, Daniel S. Berman, Stephanie L Sellers, David E NewbyMarc R Dweck, Piotr J Slomka^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

OBJECTIVES: The aim of this study was to describe the potential of 18F-sodium fluoride ( 18F-NaF) positron emission tomography (PET) to identify graft vasculopathy and to investigate the influence of coronary artery bypass graft (CABG) surgery on native coronary artery disease activity and progression.

BACKGROUND: As well as developing graft vasculopathy, CABGs have been proposed to accelerate native coronary atherosclerosis.

METHODS: Patients with established coronary artery disease underwent baseline 18F-NaF PET, coronary artery calcium scoring, coronary computed tomographic angiography, and 1-year repeat coronary artery calcium scoring. Whole-vessel coronary microcalcification activity (CMA) on 18F-NaF PET and change in calcium scores were quantified in patients with and without CABG surgery.

RESULTS: Among 293 participants (mean age 65 ± 9 years, 84% men), 48 (16%) underwent CABG surgery 2.7 years [IQR: 1.4-10.4 years] previously. Although all arterial and the majority (120 of 128 [94%]) of vein grafts showed no 18F-NaF uptake, 8 saphenous vein grafts in 7 subjects had detectable CMA. Bypassed native coronary arteries had 3 times higher CMA values (2.1 [IQR: 0.4-7.5] vs 0.6 [IQR: 0-2.7]; P < 0.001) and greater progression of 1-year calcium scores (118 Agatston unit [IQR: 48-194 Agatston unit] vs 69 [IQR: 21-142 Agatston unit]; P = 0.01) compared with patients who had not undergone CABG, an effect confined largely to native coronary plaques proximal to the graft anastomosis. In sensitivity analysis, bypassed native coronary arteries had higher CMA (2.0 [IQR: 0.4-7.5] vs 0.8 [IQR: 0.3-3.2]; P < 0.001) and faster disease progression (24% [IQR: 16%-43%] vs 8% [IQR: 0%-24%]; P = 0.002) than matched patients (n = 48) with comparable burdens of coronary artery disease and cardiovascular comorbidities in the absence of bypass grafting.

CONCLUSIONS: Native coronary arteries that have been bypassed demonstrate increased disease activity and more rapid disease progression than nonbypassed arteries, an observation that appears independent of baseline atherosclerotic plaque burden. Microcalcification activity is not a dominant feature of graft vasculopathy.

Original language	English
Pages (from-to)	875-887
Journal	JACC: Cardiovascular Imaging
Volume	15
Issue number	5
DOIs	https://doi.org/10.1016/j.jcmg.2021.11.030
Publication status	Published - 16 Feb 2022

Keywords / Materials (for Non-textual outputs)

CABG
F-NaF
PET/CT
coronary artery bypass graft
coronary artery disease

Access to Document

10.1016/j.jcmg.2021.11.030

Article cleanAccepted author manuscript, 8.04 MBLicence: Creative Commons: Attribution-NonCommercial-NoDerivatives (CC BY-NC-ND)

1 Active
5 Finished

Exploitation of the Response to Injury in Saphenous Vein Bypass Grafts
Baker, A., Hadoke, P., Henderson, N., Newby, D. & Rodor, J.
UK-based charities
1/04/20 → 31/03/25
Project: Research
Incidence, consequences and natural history of left ventricular thrombus after acute anterior myocardial infarction
Dweck, M., Newby, D. & Tzolos, E.
UK-based charities
1/02/20 → 31/01/22
Project: Research
Non-invasive detection of bicuspid aortic valve¿related thoracic aortopathy
Newby, D. & Walker, N.
UK-based charities
1/04/19 → 31/07/21
Project: Research

Edinburgh Imaging Facility
Anne Grant (Manager), Edwin van Beek (Manager) & Scott Semple (Manager)
Deanery of Clinical Sciences
Facility/equipment: Facility
Edinburgh Preclinical Imaging
Carmel Moran (Manager), Adrian Thomson (Manager), Ross J Lennen (Manager), Adriana Tavares (Manager), Carlos J. Alcaide-Corral (Manager), Tim Morgan (Other), Islay Cranston (Other) & Kerry O'Rourke (Other)
Deanery of Clinical Sciences
Facility/equipment: Facility

Cite this

Kwiecinski, J., Tzolos, E., Fletcher , A. J., Nash, J., Meah, M. N., Cadet, S., Adamson, P. D., Grodecki, K., Joshi, N., Williams, M. C., van Beek, E. J. R., Lai , C., Tavares, A. A. S., MacAskill, M. G., Dey, D., Baker, A. H., Leipsic, J., Berman, D. S., Sellers, S. L., ... Slomka, P. J. (2022). Bypass Grafting and Native Coronary Artery Disease Activity. JACC: Cardiovascular Imaging, 15(5), 875-887. https://doi.org/10.1016/j.jcmg.2021.11.030

@article{d5ddd7ba962c45cf9bdac2dcb07e914a,

title = "Bypass Grafting and Native Coronary Artery Disease Activity",

abstract = "OBJECTIVES: The aim of this study was to describe the potential of 18F-sodium fluoride ( 18F-NaF) positron emission tomography (PET) to identify graft vasculopathy and to investigate the influence of coronary artery bypass graft (CABG) surgery on native coronary artery disease activity and progression. BACKGROUND: As well as developing graft vasculopathy, CABGs have been proposed to accelerate native coronary atherosclerosis.METHODS: Patients with established coronary artery disease underwent baseline 18F-NaF PET, coronary artery calcium scoring, coronary computed tomographic angiography, and 1-year repeat coronary artery calcium scoring. Whole-vessel coronary microcalcification activity (CMA) on 18F-NaF PET and change in calcium scores were quantified in patients with and without CABG surgery. RESULTS: Among 293 participants (mean age 65 ± 9 years, 84% men), 48 (16%) underwent CABG surgery 2.7 years [IQR: 1.4-10.4 years] previously. Although all arterial and the majority (120 of 128 [94%]) of vein grafts showed no 18F-NaF uptake, 8 saphenous vein grafts in 7 subjects had detectable CMA. Bypassed native coronary arteries had 3 times higher CMA values (2.1 [IQR: 0.4-7.5] vs 0.6 [IQR: 0-2.7]; P < 0.001) and greater progression of 1-year calcium scores (118 Agatston unit [IQR: 48-194 Agatston unit] vs 69 [IQR: 21-142 Agatston unit]; P = 0.01) compared with patients who had not undergone CABG, an effect confined largely to native coronary plaques proximal to the graft anastomosis. In sensitivity analysis, bypassed native coronary arteries had higher CMA (2.0 [IQR: 0.4-7.5] vs 0.8 [IQR: 0.3-3.2]; P < 0.001) and faster disease progression (24% [IQR: 16%-43%] vs 8% [IQR: 0%-24%]; P = 0.002) than matched patients (n = 48) with comparable burdens of coronary artery disease and cardiovascular comorbidities in the absence of bypass grafting. CONCLUSIONS: Native coronary arteries that have been bypassed demonstrate increased disease activity and more rapid disease progression than nonbypassed arteries, an observation that appears independent of baseline atherosclerotic plaque burden. Microcalcification activity is not a dominant feature of graft vasculopathy.",

keywords = "CABG, F-NaF, PET/CT, coronary artery bypass graft, coronary artery disease",

author = "Jacek Kwiecinski and Evangelos Tzolos and Fletcher, {Alexander J} and Jennifer Nash and Meah, {Mohammed N} and Sebastien Cadet and Adamson, {Philip D} and Kajetan Grodecki and Nikhil Joshi and Williams, {Michelle C} and {van Beek}, {Edwin J R} and Chi Lai and Tavares, {Adriana A S} and MacAskill, {Mark G.} and Damini Dey and Baker, {Andrew H} and Jonathon Leipsic and Berman, {Daniel S.} and Sellers, {Stephanie L} and Newby, {David E} and Dweck, {Marc R} and Slomka, {Piotr J}",

note = "Funding Information: This research was supported in part by grant R01HL135557 from the National Heart, Lung, and Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Newby (CH/09/002, RE/18/5/34216, RG/16/10/32375), Dr Tzolos (FS/CRTF/20/24086), Dr Fletcher (FS/19/15/34155), Dr Baker (RG/20/5/34796), Dr Dweck (FS/14/78/31020), and Dr Williams (FS/ICRF/20/26002) are supported by the British Heart Foundation. Dr Adamson is supported by a Heart Foundation of New Zealand Senior Fellowship (1844). Dr van Beek is supported by the Scottish Imaging Network. Dr Tzolos was supported by a grant from the Dr Miriam and Sheldon G. Adelson Medical Research Foundation. Dr Newby is a recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). Dr Dweck is a recipient of the Sir Jules Thorn Award for Biomedical Research Award (2015). Dr Sellers is supported by fellowships from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",

year = "2022",

month = feb,

day = "16",

doi = "10.1016/j.jcmg.2021.11.030",

language = "English",

volume = "15",

pages = "875--887",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier",

number = "5",

}

Kwiecinski, J, Tzolos, E, Fletcher , AJ, Nash, J, Meah, MN, Cadet, S, Adamson, PD, Grodecki, K, Joshi, N, Williams, MC , van Beek, EJR, Lai , C, Tavares, AAS , MacAskill, MG, Dey, D, Baker, AH, Leipsic, J, Berman, DS, Sellers, SL, Newby, DE , Dweck, MR & Slomka, PJ 2022, 'Bypass Grafting and Native Coronary Artery Disease Activity', JACC: Cardiovascular Imaging, vol. 15, no. 5, pp. 875-887. https://doi.org/10.1016/j.jcmg.2021.11.030

TY - JOUR

T1 - Bypass Grafting and Native Coronary Artery Disease Activity

AU - Kwiecinski, Jacek

AU - Tzolos, Evangelos

AU - Fletcher , Alexander J

AU - Nash, Jennifer

AU - Meah, Mohammed N

AU - Cadet, Sebastien

AU - Adamson, Philip D

AU - Grodecki, Kajetan

AU - Joshi, Nikhil

AU - Williams, Michelle C

AU - van Beek, Edwin J R

AU - Lai , Chi

AU - Tavares, Adriana A S

AU - MacAskill, Mark G.

AU - Dey, Damini

AU - Baker, Andrew H

AU - Leipsic, Jonathon

AU - Berman, Daniel S.

AU - Sellers, Stephanie L

AU - Newby, David E

AU - Dweck, Marc R

AU - Slomka, Piotr J

N1 - Funding Information: This research was supported in part by grant R01HL135557 from the National Heart, Lung, and Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Newby (CH/09/002, RE/18/5/34216, RG/16/10/32375), Dr Tzolos (FS/CRTF/20/24086), Dr Fletcher (FS/19/15/34155), Dr Baker (RG/20/5/34796), Dr Dweck (FS/14/78/31020), and Dr Williams (FS/ICRF/20/26002) are supported by the British Heart Foundation. Dr Adamson is supported by a Heart Foundation of New Zealand Senior Fellowship (1844). Dr van Beek is supported by the Scottish Imaging Network. Dr Tzolos was supported by a grant from the Dr Miriam and Sheldon G. Adelson Medical Research Foundation. Dr Newby is a recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). Dr Dweck is a recipient of the Sir Jules Thorn Award for Biomedical Research Award (2015). Dr Sellers is supported by fellowships from the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2022 American College of Cardiology Foundation

PY - 2022/2/16

Y1 - 2022/2/16

N2 - OBJECTIVES: The aim of this study was to describe the potential of 18F-sodium fluoride ( 18F-NaF) positron emission tomography (PET) to identify graft vasculopathy and to investigate the influence of coronary artery bypass graft (CABG) surgery on native coronary artery disease activity and progression. BACKGROUND: As well as developing graft vasculopathy, CABGs have been proposed to accelerate native coronary atherosclerosis.METHODS: Patients with established coronary artery disease underwent baseline 18F-NaF PET, coronary artery calcium scoring, coronary computed tomographic angiography, and 1-year repeat coronary artery calcium scoring. Whole-vessel coronary microcalcification activity (CMA) on 18F-NaF PET and change in calcium scores were quantified in patients with and without CABG surgery. RESULTS: Among 293 participants (mean age 65 ± 9 years, 84% men), 48 (16%) underwent CABG surgery 2.7 years [IQR: 1.4-10.4 years] previously. Although all arterial and the majority (120 of 128 [94%]) of vein grafts showed no 18F-NaF uptake, 8 saphenous vein grafts in 7 subjects had detectable CMA. Bypassed native coronary arteries had 3 times higher CMA values (2.1 [IQR: 0.4-7.5] vs 0.6 [IQR: 0-2.7]; P < 0.001) and greater progression of 1-year calcium scores (118 Agatston unit [IQR: 48-194 Agatston unit] vs 69 [IQR: 21-142 Agatston unit]; P = 0.01) compared with patients who had not undergone CABG, an effect confined largely to native coronary plaques proximal to the graft anastomosis. In sensitivity analysis, bypassed native coronary arteries had higher CMA (2.0 [IQR: 0.4-7.5] vs 0.8 [IQR: 0.3-3.2]; P < 0.001) and faster disease progression (24% [IQR: 16%-43%] vs 8% [IQR: 0%-24%]; P = 0.002) than matched patients (n = 48) with comparable burdens of coronary artery disease and cardiovascular comorbidities in the absence of bypass grafting. CONCLUSIONS: Native coronary arteries that have been bypassed demonstrate increased disease activity and more rapid disease progression than nonbypassed arteries, an observation that appears independent of baseline atherosclerotic plaque burden. Microcalcification activity is not a dominant feature of graft vasculopathy.

AB - OBJECTIVES: The aim of this study was to describe the potential of 18F-sodium fluoride ( 18F-NaF) positron emission tomography (PET) to identify graft vasculopathy and to investigate the influence of coronary artery bypass graft (CABG) surgery on native coronary artery disease activity and progression. BACKGROUND: As well as developing graft vasculopathy, CABGs have been proposed to accelerate native coronary atherosclerosis.METHODS: Patients with established coronary artery disease underwent baseline 18F-NaF PET, coronary artery calcium scoring, coronary computed tomographic angiography, and 1-year repeat coronary artery calcium scoring. Whole-vessel coronary microcalcification activity (CMA) on 18F-NaF PET and change in calcium scores were quantified in patients with and without CABG surgery. RESULTS: Among 293 participants (mean age 65 ± 9 years, 84% men), 48 (16%) underwent CABG surgery 2.7 years [IQR: 1.4-10.4 years] previously. Although all arterial and the majority (120 of 128 [94%]) of vein grafts showed no 18F-NaF uptake, 8 saphenous vein grafts in 7 subjects had detectable CMA. Bypassed native coronary arteries had 3 times higher CMA values (2.1 [IQR: 0.4-7.5] vs 0.6 [IQR: 0-2.7]; P < 0.001) and greater progression of 1-year calcium scores (118 Agatston unit [IQR: 48-194 Agatston unit] vs 69 [IQR: 21-142 Agatston unit]; P = 0.01) compared with patients who had not undergone CABG, an effect confined largely to native coronary plaques proximal to the graft anastomosis. In sensitivity analysis, bypassed native coronary arteries had higher CMA (2.0 [IQR: 0.4-7.5] vs 0.8 [IQR: 0.3-3.2]; P < 0.001) and faster disease progression (24% [IQR: 16%-43%] vs 8% [IQR: 0%-24%]; P = 0.002) than matched patients (n = 48) with comparable burdens of coronary artery disease and cardiovascular comorbidities in the absence of bypass grafting. CONCLUSIONS: Native coronary arteries that have been bypassed demonstrate increased disease activity and more rapid disease progression than nonbypassed arteries, an observation that appears independent of baseline atherosclerotic plaque burden. Microcalcification activity is not a dominant feature of graft vasculopathy.

KW - CABG

KW - F-NaF

KW - PET/CT

KW - coronary artery bypass graft

KW - coronary artery disease

U2 - 10.1016/j.jcmg.2021.11.030

DO - 10.1016/j.jcmg.2021.11.030

M3 - Article

C2 - 35216930

SN - 1936-878X

VL - 15

SP - 875

EP - 887

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 5

ER -

Bypass Grafting and Native Coronary Artery Disease Activity

Abstract / Description of output

Keywords / Materials (for Non-textual outputs)

Access to Document

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Projects

Exploitation of the Response to Injury in Saphenous Vein Bypass Grafts

Incidence, consequences and natural history of left ventricular thrombus after acute anterior myocardial infarction

Non-invasive detection of bicuspid aortic valve¿related thoracic aortopathy

Equipment

Edinburgh Imaging Facility

Edinburgh Preclinical Imaging

Cite this