title: Early aortic valve inflammation precedes calcification: a longitudinal FDG-PET/CT study.
abstract: OBJECTIVE
  Recent data shows a relationship between aortic valve (AV) inflammation and calcification. However, direct evidence linking early valve inflammation (prior to hemodynamic compromise) to subsequent calcium (Ca) deposition is lacking in humans. We sought to test the hypothesis whether local AV inflammation predisposes to subsequent AV Ca deposition.
  
  
  METHODS
  We identified 111 individuals (age 60[49, 68], 50.5% male) without active cancer or aortic stenosis who underwent 2 PET/CT studies 1-5 years apart for cancer surveillance. AV inflammation was determined by measuring FDG uptake (maximum standardized uptake value, SUVmax) within the AV on baseline PET/CT. Subsequent deposition of AV Ca was determined by comparing baseline and follow-up CT scans, determined as an increase in AV Ca volume score (CaVS). Patients were classified as "non-progressors" or "progressors" based on Square Root difference in CaVS (using a pre-determined cut-off value of 2.5). CT and PET measurements were conducted by 2 mutually blinded laboratories.
  
  
  RESULTS
  During follow-up, AV Ca increased in 23 patients (20.2%) classified as "progressors", of whom 9 (9.2%) demonstrated subsequent 'incident' AV Ca. The AV SUVmax (mean ± SD) was higher in progressors vs. non-progressors (2.03 ± 0.52 vs.1.74 ± 0.36, p = 0.02) and especially in patients with-vs. without-incident AV Ca (2.28 ± 0.42 vs. 1.73 ± 0.36, p < 0.001). Moreover, AV inflammation (AV SUVmax) independently predicted subsequent calcification after adjusting for cardiovascular risk factors [OR (95%CI): 4.99 (1.30-19.15), p = 0.02].
  
  
  CONCLUSIONS
  The findings suggest that early AV inflammation may predispose to AV sclerosis. The evaluation of valvular metabolic activity may prove useful for developing a better understanding of calcific valve disease.
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Amr
authors.initials: A
authors.lastname: Abdelbaky
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Corsini
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Amparo L
authors.initials: AL
authors.lastname: Figueroa
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Sharath
authors.initials: S
authors.lastname: Subramanian
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Fontanez
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Hamed
authors.initials: H
authors.lastname: Emami
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: Division of Cardiology, Mount Sinai School of Medicine, New York City, New York.
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
authors.affiliation: Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA, USA; Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA. Electronic address: atawakol@mgh.harvard.edu.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Tawakol
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D001900:Boston / Q000453:epidemiology; D002114:Calcinosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D015999:Multivariate Analysis; D016017:Odds Ratio; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Aortic valve calcification; Aortic valve inflammation; FED-PET