Non-invasive in vivo coronary artery thrombus imaging

Evangelos Tzolos; Rong Bing; Jack Andrews; Mark G MacAskill; Adriana A S Tavares; Gillian Macnaught; Tim Clark; Nicholas L Mills; Takeshi Fujisawa; Jennifer Nash; Damini Dey; Piotr J Slomka; Norman Koglin; Andrew W. Stephens; Marcus-André Deutsch; Edwin J R  van Beek; Michelle C Williams; Sven  Hermann; Verena  Hugenberg; Marc R Dweck; David E Newby

doi:10.1016/j.jcmg.2022.10.002

Non-invasive in vivo coronary artery thrombus imaging

Evangelos Tzolos, Rong Bing, Jack Andrews, Mark G MacAskill, Adriana A S Tavares, Gillian Macnaught, Tim Clark, Nicholas L Mills, Takeshi Fujisawa, Jennifer Nash, Damini Dey, Piotr J Slomka, Norman Koglin, Andrew W. Stephens, Marcus-André Deutsch, Edwin J R van Beek, Michelle C Williams, Sven Hermann, Verena Hugenberg, Marc R DweckDavid E Newby

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

Abstract / Description of output

Background
The diagnosis and management of myocardial infarction is increasingly complex and
establishing the presence of intracoronary thrombosis has major implications for both the
classification and treatment of myocardial infarction.
Objectives
To investigate whether positron emission tomography (PET) and computed tomography (CT)
could non-invasively detect in vivo thrombus formation in human coronary arteries using a
novel glycoprotein IIb/IIIa receptor antagonist-based radiotracer, 18F-GP1.
Methods
In a single centre observational case-control study, patients with or without acute myocardial
infarction underwent coronary 18F-GP1 PET-CT angiography. Coronary artery 18F-GP1 uptake
was assessed visually and quantified using maximum target-to-background ratios.
Results
18F-GP1 PET-CT angiography was performed in 49 patients with, and 50 patients without,
acute myocardial infarction (61±9 years, 75% male). Coronary 18F-GP1 uptake was apparent
in 39 (80%) of the 49 culprit lesions in patients with acute myocardial infarction. False negative
scans appeared to relate to time delays to scan conduct and low thrombus burden in small
calibre distal arteries. On multivariable regression analysis, culprit vessel status was the only
independent variable associated with higher 18F-GP1 uptake. Extra-coronary cardiac 18F-GP1
findings included a high frequency of infarct-related intramyocardial uptake (35%) as well as
left ventricular (8%) or left atrial (2%) thrombus.
Conclusions
Coronary 18F-GP1 PET-CT angiography is the first non-invasive selective technique to identify
in vivo coronary thrombosis in patients with acute myocardial infarction. This novel approach
can further define the role and location of thrombosis within the heart and has the potential to
inform the diagnosis, management, and treatment of patients with acute myocardial infarction.

Original language	English
Journal	JACC: Cardiovascular Imaging
Early online date	14 Dec 2022
DOIs	https://doi.org/10.1016/j.jcmg.2022.10.002
Publication status	E-pub ahead of print - 14 Dec 2022

Keywords / Materials (for Non-textual outputs)

Myocardial infarction
Intracoronary thrombosis
positron emission tomography
computed tomography

Access to Document

10.1016/j.jcmg.2022.10.002

I-thrombus manuscript, trackedAccepted author manuscript, 326 KBLicence: Creative Commons: Attribution (CC-BY)

2 Active
5 Finished

Incidental coronary calcification on thoracic computed tomography
Williams, M., Mills, N. & Newby, D.
UK-based charities
1/02/21 → 31/01/26
Project: Research
High-Sensitivity Cardiac Troponin Beyond the Acute Coronary Syndrome
Mills, N., Anand, A., Chapman, A., Ferry, A., Newby, D., Strachan, F. & Tsanas, T.
UK-based charities
1/06/20 → 31/05/25
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

British Heart Foundation (BHF) Cardiovascular Biomarker Laboratory
Takeshi Fujisawa (Manager)
Deanery of Clinical Sciences
Facility/equipment: Facility
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

Tzolos, E., Bing, R., Andrews, J., MacAskill, M. G., Tavares, A. A. S., Macnaught, G., Clark, T., Mills, N. L., Fujisawa, T., Nash, J., Dey, D., Slomka, P. J., Koglin, N., Stephens, A. W., Deutsch, M.-A., van Beek, E. J. R., Williams, M. C., Hermann, S., Hugenberg, V., ... Newby, D. E. (2022). Non-invasive in vivo coronary artery thrombus imaging. JACC: Cardiovascular Imaging. Advance online publication. https://doi.org/10.1016/j.jcmg.2022.10.002

@article{91de651dc3b74f4eacf223a7cec265bd,

title = "Non-invasive in vivo coronary artery thrombus imaging",

abstract = "BackgroundThe diagnosis and management of myocardial infarction is increasingly complex andestablishing the presence of intracoronary thrombosis has major implications for both theclassification and treatment of myocardial infarction.ObjectivesTo investigate whether positron emission tomography (PET) and computed tomography (CT)could non-invasively detect in vivo thrombus formation in human coronary arteries using anovel glycoprotein IIb/IIIa receptor antagonist-based radiotracer, 18F-GP1.MethodsIn a single centre observational case-control study, patients with or without acute myocardialinfarction underwent coronary 18F-GP1 PET-CT angiography. Coronary artery 18F-GP1 uptakewas assessed visually and quantified using maximum target-to-background ratios.Results18F-GP1 PET-CT angiography was performed in 49 patients with, and 50 patients without,acute myocardial infarction (61±9 years, 75% male). Coronary 18F-GP1 uptake was apparentin 39 (80%) of the 49 culprit lesions in patients with acute myocardial infarction. False negativescans appeared to relate to time delays to scan conduct and low thrombus burden in smallcalibre distal arteries. On multivariable regression analysis, culprit vessel status was the onlyindependent variable associated with higher 18F-GP1 uptake. Extra-coronary cardiac 18F-GP1findings included a high frequency of infarct-related intramyocardial uptake (35%) as well asleft ventricular (8%) or left atrial (2%) thrombus.ConclusionsCoronary 18F-GP1 PET-CT angiography is the first non-invasive selective technique to identifyin vivo coronary thrombosis in patients with acute myocardial infarction. This novel approachcan further define the role and location of thrombosis within the heart and has the potential toinform the diagnosis, management, and treatment of patients with acute myocardial infarction.",

keywords = "Myocardial infarction, Intracoronary thrombosis, positron emission tomography, computed tomography",

author = "Evangelos Tzolos and Rong Bing and Jack Andrews and MacAskill, {Mark G} and Tavares, {Adriana A S} and Gillian Macnaught and Tim Clark and Mills, {Nicholas L} and Takeshi Fujisawa and Jennifer Nash and Damini Dey and Slomka, {Piotr J} and Norman Koglin and Stephens, {Andrew W.} and Marcus-Andr{\'e} Deutsch and {van Beek}, {Edwin J R} and Williams, {Michelle C} and Sven Hermann and Verena Hugenberg and Dweck, {Marc R} and Newby, {David E}",

year = "2022",

month = dec,

day = "14",

doi = "10.1016/j.jcmg.2022.10.002",

language = "English",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier",

}

Tzolos, E, Bing, R, Andrews, J, MacAskill, MG , Tavares, AAS, Macnaught, G, Clark, T, Mills, NL , Fujisawa, T, Nash, J, Dey, D, Slomka, PJ, Koglin, N, Stephens, AW, Deutsch, M-A, van Beek, EJR , Williams, MC, Hermann, S, Hugenberg, V, Dweck, MR & Newby, DE 2022, 'Non-invasive in vivo coronary artery thrombus imaging', JACC: Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2022.10.002

TY - JOUR

T1 - Non-invasive in vivo coronary artery thrombus imaging

AU - Tzolos, Evangelos

AU - Bing, Rong

AU - Andrews, Jack

AU - MacAskill, Mark G

AU - Tavares, Adriana A S

AU - Macnaught, Gillian

AU - Clark, Tim

AU - Mills, Nicholas L

AU - Fujisawa, Takeshi

AU - Nash, Jennifer

AU - Dey, Damini

AU - Slomka, Piotr J

AU - Koglin, Norman

AU - Stephens, Andrew W.

AU - Deutsch, Marcus-André

AU - van Beek, Edwin J R

AU - Williams, Michelle C

AU - Hermann, Sven

AU - Hugenberg, Verena

AU - Dweck, Marc R

AU - Newby, David E

PY - 2022/12/14

Y1 - 2022/12/14

N2 - BackgroundThe diagnosis and management of myocardial infarction is increasingly complex andestablishing the presence of intracoronary thrombosis has major implications for both theclassification and treatment of myocardial infarction.ObjectivesTo investigate whether positron emission tomography (PET) and computed tomography (CT)could non-invasively detect in vivo thrombus formation in human coronary arteries using anovel glycoprotein IIb/IIIa receptor antagonist-based radiotracer, 18F-GP1.MethodsIn a single centre observational case-control study, patients with or without acute myocardialinfarction underwent coronary 18F-GP1 PET-CT angiography. Coronary artery 18F-GP1 uptakewas assessed visually and quantified using maximum target-to-background ratios.Results18F-GP1 PET-CT angiography was performed in 49 patients with, and 50 patients without,acute myocardial infarction (61±9 years, 75% male). Coronary 18F-GP1 uptake was apparentin 39 (80%) of the 49 culprit lesions in patients with acute myocardial infarction. False negativescans appeared to relate to time delays to scan conduct and low thrombus burden in smallcalibre distal arteries. On multivariable regression analysis, culprit vessel status was the onlyindependent variable associated with higher 18F-GP1 uptake. Extra-coronary cardiac 18F-GP1findings included a high frequency of infarct-related intramyocardial uptake (35%) as well asleft ventricular (8%) or left atrial (2%) thrombus.ConclusionsCoronary 18F-GP1 PET-CT angiography is the first non-invasive selective technique to identifyin vivo coronary thrombosis in patients with acute myocardial infarction. This novel approachcan further define the role and location of thrombosis within the heart and has the potential toinform the diagnosis, management, and treatment of patients with acute myocardial infarction.

AB - BackgroundThe diagnosis and management of myocardial infarction is increasingly complex andestablishing the presence of intracoronary thrombosis has major implications for both theclassification and treatment of myocardial infarction.ObjectivesTo investigate whether positron emission tomography (PET) and computed tomography (CT)could non-invasively detect in vivo thrombus formation in human coronary arteries using anovel glycoprotein IIb/IIIa receptor antagonist-based radiotracer, 18F-GP1.MethodsIn a single centre observational case-control study, patients with or without acute myocardialinfarction underwent coronary 18F-GP1 PET-CT angiography. Coronary artery 18F-GP1 uptakewas assessed visually and quantified using maximum target-to-background ratios.Results18F-GP1 PET-CT angiography was performed in 49 patients with, and 50 patients without,acute myocardial infarction (61±9 years, 75% male). Coronary 18F-GP1 uptake was apparentin 39 (80%) of the 49 culprit lesions in patients with acute myocardial infarction. False negativescans appeared to relate to time delays to scan conduct and low thrombus burden in smallcalibre distal arteries. On multivariable regression analysis, culprit vessel status was the onlyindependent variable associated with higher 18F-GP1 uptake. Extra-coronary cardiac 18F-GP1findings included a high frequency of infarct-related intramyocardial uptake (35%) as well asleft ventricular (8%) or left atrial (2%) thrombus.ConclusionsCoronary 18F-GP1 PET-CT angiography is the first non-invasive selective technique to identifyin vivo coronary thrombosis in patients with acute myocardial infarction. This novel approachcan further define the role and location of thrombosis within the heart and has the potential toinform the diagnosis, management, and treatment of patients with acute myocardial infarction.

KW - Myocardial infarction

KW - Intracoronary thrombosis

KW - positron emission tomography

KW - computed tomography

U2 - 10.1016/j.jcmg.2022.10.002

DO - 10.1016/j.jcmg.2022.10.002

M3 - Article

SN - 1936-878X

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

ER -

Non-invasive in vivo coronary artery thrombus imaging

Abstract / Description of output

Keywords / Materials (for Non-textual outputs)

Access to Document

Fingerprint

Projects

Incidental coronary calcification on thoracic computed tomography

High-Sensitivity Cardiac Troponin Beyond the Acute Coronary Syndrome

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

Equipment

British Heart Foundation (BHF) Cardiovascular Biomarker Laboratory

Edinburgh Imaging Facility

Edinburgh Preclinical Imaging

Cite this