Cardiovascular Molecular Calcification Assessed by 18F-NaF PET CT

• Conditions: Cardiovascular Disease; Atherosclerosis; Angina Pectoris

• Registration Number: NCT01724749
• Lead Sponsor: Odense University Hospital

Brief Summary

The purpose of the CAMONA study is to demonstrate the feasibility of cardiovascular molecular calcification (CMC) assessment by means of 18F-sodium-fluoride (18F-NaF) positron emission tomography (PET) computed tomography (CT) in a prospective cohort of healthy control subjects and subjects with cardiovascular disease.

Detailed Description

Atherosclerosis associated cardiovascular disease (CVD) remains a significant cause of morbidity and mortality. Asymptomatic individuals with a moderate to high-risk of developing acute atherosclerotic cardiovascular events will benefit most from intensive evidence-based medical interventions.

The traditional approach to identify patients with moderate to high-risk of CVD involves quantifying the presence of CVD risk factors. Based on gender, age, smoking, systolic blood pressure and cholesterol levels, risk stratification algorithms such as the Framingham Risk Score (FRS) and the European SCORE system can predict the 10-year risk of cardiovascular death.

However, these algorithms are associated with several limitations, including misclassification of women and individuals with high levels of a single risk factor. The risk is underestimated in these individuals. Therefore, these individuals are not eligible for treatment by current criteria of CVD prevention guidelines. Several studies indicate that the traditional risk score models leave room for improvement, as they work reasonably well for populations, but remain suboptimal for individual subjects.

New risk parameters are discovered on a regular basis. One of these parameters is cardiovascular molecular calcification (CMC). This entity can be detected and quantified by 18F-NaF PET CT. It has been hypothesized that CMC can be detected years, maybe even decades, before coronary artery calcium scoring (CACS) can be detected by conventional imaging modalities like multislice CT. Theoretically, this tool can detect patients at a very early stage of the disease. Providing evidence-based treatment to these individuals can, theoretically, improve the prevention of CVD. Before this hypothesises can be tested, the feasibility of 18F-NaF PET CT has to be demonstrated in both healthy controls as well as in subjects with cardiovascular disease.

Study Timeline

• Status Verified: 2012-11
• Study Start: 2012-11
• Study First Submitted: 2012-11-06
• Study First Submitted QC: 2012-11-07
• Last Update Submitted: 2012-11-07
• Study First Posted: 2012-11-12
• Last Update Posted: 2012-11-12
• Primary Completion: 2014-11
• Study Completion: 2016-12

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 144

Inclusion Criteria

• Age: 21 - 80 years
• Healthy controls: No prior history or symptoms of cardiovascular disease
• Cardiology subjects: Eligibility for CACS due to symptoms suggesting angina pectoris.
• Cardiology subjects: HeartSCORE > 0%.

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Exclusion Criteria

• Pregnancy
• Extensive physical activity or extensive partying passed 24 hours
• History of malignant neoplasms with past 5 years
• Known immunodeficiencies
• History of deep vein thrombosis or acute pulmonary embolism within the previous three months
• History of alcohol abuses, illicit drug use, or drug abuse, or significant mental illness
• Initiation of statin-therapy within 3 months prior to consideration of study enrolment
• History of autoimmune disease, such as systemic lupus erythematosus, inflammatory bowel disease, sarcoidosis, rheumatoid arthritis, or psoriasis.
• Participation in any clinical trial of an investigational drug, device, or medical procedure within 30 days prior to baseline of the study
• Enrolment or planned enrolment in another clinical trial during the study period

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Target to background ratio (TBR) of 18F-NaF	Up to 7 days after the day of PET CT acquisition	The TBR is a validated semi-quantitative assessment of PET radiotracer uptake. The TBR of 18F-NaF will be determined in the aorta, carotid arteries, coronary arteries, iliac arteries and the femoral arteries.
Standardized uptake value (SUV) of 18F-NaF	Up to 7 days after the day of PET CT acquisition	The SUV is a validated semi-quantitative assessment of PET radiotracer uptake. The SUV of 18F-NaF will be determined in the aorta, carotid arteries, coronary arteries, iliac arteries and the femoral arteries.

Secondary Outcome Measures

Name	Time	Method
Correlations between 18F-NaF TBR, 18F-FDG TBR, and CT calcification scoring	Up to 7 days after the day of PET CT acquisition	Correlation between the degree of 18F-NaF uptake, 18F-FDG uptake, CT-Calcification scoring and the various arterial segments (aorta, carotid arteries, iliac arteries and the femoral arteries.
Target to background ratio (TBR) of 18F-NaF	Up to 7 days after the day of PET CT acquisition	18F-NaF PET/CT images will be acquired at 45, 90 and 180 minutes after intravenous injection of the compound in a subset of 40 patients. The TBR of 18F-NaF will be determined at each time point and compared to allow determining the optimum tracer circulation time for maximum contrast between the vessel wall and blood pool.
Correlation between 18F-NaF / 18F-FDG uptake and 18F-FDG uptake in the brain	Up to 7 days after the day of PET CT acquisition	18F-FDG uptake in the brain will be quantified by calculating the mean and maximum partial-volume corrected SUV.
Correlation between the TBR of 18F-NaF/18F-FDG and traditional cardiovascular risk factors.	The cardiovascular risk factors will be determined, on average, 1 hour before 18F-NaF / 18F-FDG injection; which ever comes first	The traditional cardiovascular risk factors consist of: 1. Smoking, pack years; 2. Alcohol, units/week; 3. Blood pressure, mean arterial pressure, mmHg; 4. Body mass index, kg/m2; 5. Waist circumference, cm; 6. History of cardiovascular disease; 7. Family history of cardiovascular disease; 8. Medication usage; 9. Age; 10. Gender.
Standardized uptake value (SUV) of 18F-Fluorodeoxyglucose (18F-FDG)	Up to 7 days after the day of PET CT acquisition	The SUV is a validated semi-quantitative assessment of PET radiotracer uptake. The SUV of 18F-FDG will be determined in the aorta, carotid arteries, iliac arteries and the femoral arteries.
Target to background ratio (TBR) of 18F-FDG	Up to 7 days after the day of PET CT acquisition	18F-FDG PET/CT images will be acquired at 90 and 180 minutes after intravenous injection of the compound in a subset of 40 patients. The TBR of 18F-NaF will be determined at both time points and compared to allow determining the optimum tracer circulation time for maximum contrast between the vessel wall and blood pool.
Correlation between the TBR of 18F-NaF/18F-FDG and blood markers of atherosclerosis.	The blood draw will be performed, on average, 1 hour before the 18F-FDG PET CT scan and the blood markers will determined in upto 48 hours after the 18F-FDG PET CT scan	Blood markers: 1. Total cholesterol, mmol/L; 2. LDL cholesterol, mmol/L; 3. HDL cholesterol, mmol/L; 4. Triglycerides, mmol/L; 5. Homocysteine, mmol/L; 6. Fasting plasma glucose, mmol/L; 7. HBA1c, mmol/mol; 8. High sensitivity C-reactive protein, nmol/L; 9. Fibrinogen, umol/L; 10. Leukocyte differentiation, cells/L; 11. Creatinine, umol/L;
Correlation between 18F-NaF TBR and 18F-NaF TBR two years after the baseline scan.	2 years	The TBR will be determined in various segments of the arterial tree.
Correlation between 18F-FDG TBR and 18F-FDG TBR two years after the baseline scan.	2 years	The TBR will be determined in various segments of the arterial tree.
Correlation between the TBR of 18F-NaF/18F-FDG and HeartSCORE	Up to 7 days after the day of PET CT acquisition	The HeartSCORE will be calculated according to the current HeartSCORE protocol for Denmark.
Correlation between the TBR of 18F-NaF/18F-FDG and Framingham Risk Score	Up to 7 days after the day of PET CT acquisition	The Framingham Risk Score will be calculated according to the current recommendations by the Framingham Heart Study group
Correlation between 18F-NaF / 18F-FDG uptake and 18F-NaF / 18F-FDG uptake in the vertebral body	Up to 7 days after the day of PET CT acquisition	18F-NaF uptake in the 1st, 3rd and 5th lumbar vertebral body will be quantified by calculating the mean and maximum partial-volume corrected SUV.
Arterial Calcification Score	Up to 7 days after the day of PET CT acquisition	Arterial Calcification Scoring will be determined in Agatston Units as well as in volumetric units in all segments of the arterial tree (coronary arteries, aorta, carotid arteries, iliac and femoral arteries.

Trial Locations

Locations (2)

Department of Cardiology, Odense University Hospital; 🇩🇰 Odense, Region Syddanmark, Denmark

Department of Nuclear Medicine, Odense University Hospital; 🇩🇰 Odense, Region Syddanmark, Denmark