Exploring the relationship between aortic valve microcalcification and cardiovascular risk factors with 18F-NaF PET-CT

Abstract Introduction 18F-NaF-PET-CT (Positron emission tomography­ computed tomography with 18F­sodium fluoride) can identify active microcalcification. Epidemiologic associations between cardiovascular (CV) risk factors and calcific aortic valve disease have been described, but the pathophysiologic links remain unclear. Purpose The aim of this study was to explore the relationship between aortic valve microcalcification and a number of cardiovascular risk factors. Methods Individuals at high CV risk but no prior events or known aortic valve disease were prospectively scanned with 18F-NaF-PET-CT. Aortic valve 18F-NaF uptake was quantified via the CUL (corrected uptake per lesion = maximum standard uptake value – mean blood-pool standard uptake value in the atria) and the TBR (tissue-to-background ratio = maximum standard uptake value/mean blood-pool standard uptake value in the atria). Results Thirty patients were included. Mean age was 63.7 ± 9.5 years, 70.0% were male, most were diabetic and hypertensive (93.3%). Both the TBR and the CUL were positively correlated with age (TBR: rho = 0.53, p = 0.0025; CUL: rho = 0.56, p = 0.0012). Whereas the CUL but not TBR was inversely correlated with the estimated glomerular filtration rate (TBR: cor -0.24, p = 0.196; CUL: cor -0.37, p = 0.04). There was no significant association with other CV risk factors. Conclusions In our cohort, age and the estimated glomerular filtration rate were correlated with the aortic valve uptake of 18F­NaF. Larger studies are required to validate these findings and determine the role of microcalcification in aortic valve degeneration.