Key result
Increased [68 Ga]Ga-DOTA-TOC uptake in coronary plaques is linked to ~22% mortality and higher stroke risk.
Why the study?
Inflamed, rupture-prone coronary plaques are important causes of myocardial infarction, and current PET scanners may have suboptimal sensitivity for imaging coronary artery inflammation.
Observational (n=108)
No
Absolute Event Rate: 15.63% vs 0%
p-value: p=0.001
[68 Ga]Ga-DOTA-TOC LAFOV PET/CT can identify inflamed calcified coronary plaques, which correlates with a higher risk of stroke and all-cause death.
Hypothesis-generating for [68Ga]Ga-DOTA-TOC PET in coronary plaque risk; should not yet change clinical practice.
Purpose Inflamed, prone-to-rupture coronary plaques are an important cause of myocardial infarction and their early identification is crucial. Atherosclerotic plaques are characterized by overexpression of the type-2 somatostatin receptor (SST2) in activated macrophages. SST2 ligand imaging (e.g. with [68 Ga]Ga-DOTA-TOC) has shown promise in detecting and quantifying the inflammatory activity within atherosclerotic plaques. However, the sensitivity of standard axial field of view (SAFOV) PET scanners may be suboptimal for imaging coronary arteries. Long-axial field of view (LAFOV) PET/CT scanners may help overcome this limitation. We aim to assess the ability of [68 Ga]Ga-DOTA-TOC LAFOV-PET/CT in detecting calcified, SST2 overexpressing coronary artery plaques. Methods In this retrospective study, 108 oncological patients underwent [68 Ga]Ga-DOTA-TOC PET/CT on a LAFOV system. [68 Ga]Ga-DOTA-TOC uptake and calcifications in the coronary arteries were evaluated visually and semi-quantitatively. Data on patients’ cardiac risk factors and coronary artery calcium score were also collected. Patients were followed up for 21.5 ± 3.4 months. Results A total of 66 patients (61.1%) presented with calcified coronary artery plaques. Of these, 32 patients had increased [68 Ga]Ga-DOTA-TOC uptake in at least one coronary vessel (TBR: 1.65 ± 0.53). Patients with single-vessel calcifications showed statistically significantly lower uptake (SUVmax 1.10 ± 0.28) compared to patients with two- (SUVmax 1.31 ± 0.29, p < 0.01) or three-vessel calcifications (SUVmax 1.24 ± 0.33, p < 0.01). There was a correlation between coronary artery calcium score (CACS) and [68 Ga]Ga-DOTA-TOC uptake, especially in the LAD (p = 0.02). Stroke and all-cause death occurred more frequently in patients with increased [68 Ga]Ga-DOTA-TOC uptake (15.63% vs. 0%; p:0.001 and 21.88% vs. 6.58%; p: 0.04, respectively) during the follow-up period. Conclusion [68 Ga]Ga-DOTA-TOC as a marker for the macrophage activity can reveal unknown cases of inflamed calcified coronary artery plaques using a LAFOV PET system. [68 Ga]Ga-DOTA-TOC uptake increased with the degree of calcification and correlated with higher risk of stroke and all-cause death. [68 Ga]Ga-DOTA-TOC LAFOV PET/CT may be useful to assess patients’ cardiovascular risk.
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Mingels et al. (2023) conducted an observational in Oncological patients without known coronary artery disease (n=108). Increased [68 Ga]Ga-DOTA-TOC uptake in calcified coronary artery plaques vs. No increased [68 Ga]Ga-DOTA-TOC uptake was evaluated on Stroke (p=0.001). Increased [68 Ga]Ga-DOTA-TOC uptake in calcified coronary artery plaques was associated with a significantly higher incidence of stroke (15.63% vs. 0%) and all-cause death (21.88% vs. 6.58%).
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