Vascular biomechanics and molecular disease activity in the thoracic aorta: a novel imaging method

Savine C.S. Minderhoud, Alexander J Fletcher , Gillian MacNaught, Sebastien Cadet, Suze-Anne Korteland, Isabella Kardys, Dimitris Rizopoulos , Piotr Slomka, David E Newby, Jolien W. Roos-Hesselink, Niki L Walker, Scott Semple, Alexander Hirsch, Marc R Dweck*, Jolanda J Wentzel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Aims
The influence haemodynamics have on vessel wall pathobiology in aortic disease is incomplete. This aim of this study was to develop a repeatable method for assessing the relationship between aortic wall shear stress (WSS) and disease activity by fusing 4D flow cardiovascular magnetic resonance (CMR) with hybrid positron emission tomography (PET).

Methods and results
As part of an ongoing clinical trial, patients with bicuspid aortic valve (BAV) were prospectively imaged with both 18F-sodium fluoride (18F-NaF) PET, a marker of calcification activity, and 4D flow CMR. We developed novel software allowing accurate three-dimensional co-registration and high-resolution comparison of aortic peak systolic WSS and 18F-NaF PET uptake (maximum tissue-to-background ratio (TBR)). Intra-observer repeatability of both measurements was determined using Bland-Altman plots and intra-class correlation coefficients (ICC). The relationship between localised WSS and 18F-NaF uptake was analysed using linear mixed-effect models.

Twenty-three patients with BAV (median age 50 [44-55] years, 22% female) were included. Intra-observer repeatability for WSS (ICC=0.92) and 18F-NaF (ICC=0.91) measurements obtained within 1.4±0.6 cm2 regions of interest was excellent. On multivariable analysis, 18F-NaF PET uptake was independently and negatively associated with WSS as well as diastolic blood pressure (both p<0.05), adjusted for age.

Conclusion
Fused assessment of WSS and 18F-NaF PET uptake is feasible and repeatable, demonstrating a clear association between these two factors. This high spatial resolution approach has major potential to advance our understanding of the relationship between vascular haemodynamics and disease activity.
Original languageEnglish
JournalEuropean Heart Journal - Cardiovascular Imaging
Early online date6 Jun 2022
DOIs
Publication statusE-pub ahead of print - 6 Jun 2022

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