Early aortic valve inflammation precedes calcification: a longitudinal FDG-PET/CT study

Area of Science:

• Cardiovascular Imaging
• Inflammation Research
• Biomarker Discovery

Background:

• Aortic valve (AV) calcification is a growing concern, with recent data suggesting a link to AV inflammation.
• However, direct human evidence connecting early, pre-symptomatic AV inflammation to later calcium deposition is scarce.

Purpose of the Study:

• To investigate whether local AV inflammation precedes and predisposes individuals to subsequent AV calcium deposition.
• To establish a link between early inflammatory markers and the progression of AV calcification.

Main Methods:

• 111 individuals without active cancer or aortic stenosis underwent serial PET/CT scans 1-5 years apart.
• Aortic valve inflammation was quantified using FDG uptake (SUVmax) on baseline PET/CT.
• Subsequent AV calcium deposition was assessed by changes in AV calcium volume score (CaVS) on follow-up CT scans.

Main Results:

• 20.2% of patients showed increased AV calcium, with 9.2% developing incident calcification.
• Higher baseline AV inflammation (SUVmax) was observed in patients with progressing calcification (p=0.02) and incident calcification (p<0.001).
• AV inflammation independently predicted subsequent AV calcification (OR: 4.99, p=0.02), even after adjusting for cardiovascular risk factors.

Conclusions:

• Early aortic valve inflammation is a significant predictor of subsequent aortic valve calcification.
• Evaluating valvular metabolic activity may enhance understanding of calcific valve disease pathogenesis.
• These findings suggest inflammation may be an early driver of aortic valve sclerosis.