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FDG-PET imaging illuminates role of inflammation in aortic stenosis
Marincheva-Savcheva G. J Am Coll Cardiol. 2011;57:2507-2515.
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New findings from a preliminary study published in the Journal of the American College of Cardiology have shown the presence of inflammation among patients with aortic stenosis through the use of fluorodeoxyglucose PET imaging.
“This study demonstrates for the first time that fluorodeoxyglucose (FDG) uptake is increased within aortic valves of patients with aortic stenosis,” the researchers wrote. “We found that FDG uptake is increased in mild and moderate [aortic stenosis], but not in the more severe stage of the disease.”
In the retrospective study, 84 patients (mean age, 73 years), 42 with aortic stenosis and 42 age-matched controls, were examined. Researchers assessed FDG uptake via FDG-PET while blinded to aortic stenosis severity. They also used echocardiography to assess stenosis severity and CT to determine aortic valve calcification.
Among patients with aortic stenosis, the disease was mild in 18 patients, moderate in 16 patients and severe in eight patients. Compared with controls, the aortic valve PET signal or target-to-background ratio was increased in those with aortic stenosis (P<.001).
Further comparison to controls also indicated that target-to-background ratio was higher for patients with mild (P=.01) and moderate (P<.001) disease, but not for those with severe aortic stenosis (P=.08). Similarly, categorization by aortic valve calcification also suggested that FDG uptake was increased in mild (P<.01) and moderate (P<.001) aortic stenosis patients, but not in those with severe disease (P=.15).
“FDG-PET/CT imaging potentially represents a novel molecular imaging method for characterizing the biological activity within the aortic valve,” the researchers wrote in the concluding section of the study. “This technique, once further validated, may provide new opportunities for risk stratification of patients and for identification of treatments to modify the progression of [aortic stenosis].”
An important step in the process of validation, they said, is to prospectively test whether the FDG-PET signal is associated with progression of aortic stenosis.
“If such a study demonstrates that the PET signal predicts progression, then the imaging tool might be used to identify anti-inflammatory agents that modify valvular inflammation,” the researchers said. “Indeed, the ability to noninvasively assess aortic valve inflammation at molecular level would likely serve as a powerful stimulus for intensification of efforts to develop such therapies aimed at aortic valve stenosis.”
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