¹⁸F-Sodium Fluoride Positron Emission Tomography Activity Predicts the Development of New Coronary Artery...

The coronary calcium score (CCS) predicts cardiovascular disease risk in individuals with diabetes, and rate of progression of CCS is an additional and incremental marker of risk. ¹⁸F-sodium fluoride positron emission tomography (¹⁸F-NaF PET) detects early and active calcifications within the vasculature. We aimed to ascertain the relationship between ¹⁸F-NaF PET activity and CCS progression in patients with diabetes. Approach and Results: We identified individuals between 50 and 80 years with diabetes and no history of clinical coronary artery disease. Those with a CCS ≥10 were invited to undergo ¹⁸F-NaF PET scanning and then repeat CCS >2 years later. ¹⁸F-NaF PET and CCS analysis were performed on a per-coronary and a per-patient level. We compared the proportion of CCS progressors in ¹⁸F-NaF PET-positive versus ¹⁸F-NaF PET-negative coronary arteries. Forty-one participants with 163 coronary arteries underwent follow-up CCS 2.8±0.5 years later. ¹⁸F-NaF PET-positive coronary arteries (n=52) were more likely to be CCS progressors, compared with negative coronary arteries (n=111; 86.5% versus 52.3%, P<0.001). Adjusting for baseline CCS, ¹⁸F-NaF PET-positive disease was an independent predictor of subsequent CCS progression (odds ratio, 2.92 [95% CI, 1.32-6.45], P=0.008). All subjects (100%, 15/15) with ≥2 ¹⁸F-NaF-positive coronary arteries progressed in CCS.

In subjects with diabetes, ¹⁸F-NaF PET positivity at baseline, independently predicted the progression of calcifications within the coronary arteries 2.8 years later. These findings suggest ¹⁸F-NaF PET may be a promising technique for earlier identification of patients at higher risk of cardiovascular events.