title: Prognostic value of (18)F-fluorodeoxyglucose PET-CT imaging in acute aortic syndromes: comparison with serological biomarkers of inflammation.
abstract: Aim of this study was to investigate the relationship between (18)F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) findings and serological biomarkers of inflammation and the related discriminant value of unfavourable outcome during follow-up in patients with acute aortic syndromes (AAS). Sixty patients with AAS underwent PET-CT imaging during the hospitalization along with measurement of C-reactive protein (CRP) and D-dimer (D-d) serum levels. An aortic wall pathology was considered PET-positive by a maximum standardized uptake value (SUVmax) >2.5. A combined endpoint of major adverse events (MAE) including aorta-related mortality, disease progression and re-intervention was used to compare patient subgroups at 3-year follow-up. PET-CT detected an elevated FDG uptake within the aortic wall in 25 (41.7%) patients. PET-positive patients showed significantly increased CRP levels (10.0 ± 6.6 mg/dL) and tended to higher D-d levels (5.1 ± 3.9 mg/L), compared to PET-negative patients (5.8 ± 6.1 mg/dL and 3.1 ± 4.7 mg/L respectively; P = 0.048, P = 0.19). At 3-year follow-up, all-cause mortality and MAE were higher in the PET-positive (21.7 and 47.8% respectively) than PET-negative group (0.0 and 13.3% respectively; P = 0.012, P = 0.006). On Kaplan-Meier analysis, PET-positive patients were at higher risk of MAE (P = 0.031). This tendency was more evident by combining PET results with D-d levels at a cutoff value of 4.8 mg/L (P < 0.001). In patients with AAS, a pathological glucose uptake in aortic wall lesions by PET-CT was associated with high CRP levels and increased mortality and MAE at 3-year follow-up. The combination of PET results with D-d levels had the best discriminant value of MAE.
authors.affiliation: Department of Cardiology, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.|Cardiology Clinic, "Ospedale di Circolo" Varese, University of Insubria, Varese, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gorla
authors.affiliation: Department of Cardiology, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany. raimund.erbel@uk-essen.de.|West-German Heart and Vascular Center Essen, University Clinic of Cardiology, Hufelandstrasse 55, 45147, Essen, Germany. raimund.erbel@uk-essen.de.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Hilmar
authors.initials: H
authors.lastname: Kuehl
authors.affiliation: Department of Cardiology, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.affiliation: Department of Cardiology, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Amir-Abbas
authors.initials: AA
authors.lastname: Mahabadi
authors.affiliation: Department of Radiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schlosser
authors.affiliation: Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bockisch
authors.affiliation: Cardioangiological Center Bethanien, Frankfurt am Main, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.affiliation: "Heart" Department, University Hospital, Salerno, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: Department of Cardiology, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Rolf Alexander
authors.initials: RA
authors.lastname: Jánosi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016002:Discriminant Analysis; D018450:Disease Progression; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage*; D006760:Hospitalization; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D012698:Serologic Tests; D013577:Syndrome; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D018836:Inflammation Mediators; D019275:Radiopharmaceuticals; C036309:fibrin fragment D; D019788:Fluorodeoxyglucose F18; D002097:C-Reactive Protein
keywords: Acute aortic syndromes; C-reactive protein; D-dimer; PET-CT