title: Imaging of the aortic valve using fluorodeoxyglucose positron emission tomography increased valvular fluorodeoxyglucose uptake in aortic stenosis.
abstract: OBJECTIVE
  Because fluorodeoxyglucose positron emission tomography (FDG-PET) imaging provides a noninvasive index of inflammation, we sought to assess whether FDG uptake in the aortic valve (AV) is increased in aortic stenosis (AS).
  
  
  BACKGROUND
  AS is associated with valvular inflammation.
  
  
  METHODS
  FDG-PET/computed tomography data were retrospectively evaluated in 84 patients (age 73 ± 9 years, 45% female), 42 patients with AS, and 42 age-matched controls. FDG uptake was determined within the AV while blinded to AS severity. Target-to-background ratio (TBR) was calculated as valvular/blood activity. Stenosis severity was established on echocardiography, and presence of AV calcification was independently assessed on computed tomography.
  
  
  RESULTS
  The aortic valve PET signal (TBR) was increased in AS compared with controls (median 1.53 [interquartile range (IQR): 1.42 to 1.76] vs. 1.34 [IQR: 1.20 to 1.55]; p < 0.001). Further, compared with controls, TBR was increased in mild (median 1.50 [IQR: 1.36 to 1.75]; p = 0.01) and moderate (median 1.70 [IQR: 1.52 to 1.94]; p < 0.001), but not in severe AS (median 1.49 [IQR: 1.40 to 1.54]; p = 0.08). When subjects were categorized according to AV calcification, valvular FDG uptake was increased in mildly (median 1.50 [IQR: 1.36 to 1.79]; p < 0.01) and moderately (median 1.67 [IQR: 1.50 to 1.85]; p < 0.001), but not severely calcified valves (median 1.51 [IQR: 1.38 to 1.54]; p = 0.15), compared with noncalcified valves (median 1.35 [IQR: 1.20 to 1.52]).
  
  
  CONCLUSIONS
  This study supports the hypothesis that AS is an inflammatory condition and suggests that inflammation may be reduced in late-stage disease. This may have important implications in the design of studies assessing the effect of therapeutic agents in modifying progression of AS.
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Gergana
authors.initials: G
authors.lastname: Marincheva-Savcheva
authors.forename: Sharath
authors.initials: S
authors.lastname: Subramanian
authors.forename: Sadia
authors.initials: S
authors.lastname: Qadir
authors.forename: Amparo
authors.initials: A
authors.lastname: Figueroa
authors.forename: Quynh
authors.initials: Q
authors.lastname: Truong
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Vijayakumar
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Brady
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Ahmed
authors.initials: A
authors.lastname: Tawakol
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007249:Inflammation / Q000175:diagnosis*; D008297:Male; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18