1st Department of Cardiology, Athens Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Dionysiou Aiginitou 8, 11528, Athens, Greece.
General Hospital 'Evaggelismos', Athens, Greece.
J Nucl Cardiol. 2023 Feb;30(1):74-82. doi: 10.1007/s12350-022-02962-1. Epub 2022 May 2.
Arterial involvement has been implicated in the coronavirus disease of 2019 (COVID-19). Fluorine 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging is a valuable tool for the assessment of aortic inflammation and is a predictor of outcome. We sought to prospectively assess the presence of aortic inflammation and its time-dependent trend in patients with COVID-19.
Between November 2020 and May 2021, in this pilot, case-control study, we recruited 20 patients with severe or critical COVID-19 (mean age of 59 ± 12 years), while 10 age and sex-matched individuals served as the control group. Aortic inflammation was assessed by measuring F-FDG uptake in PET/CT performed 20-120 days post-admission. Global aortic target to background ratio (GLA-TBR) was calculated as the sum of TBRs of ascending and descending aorta, aortic arch, and abdominal aorta divided by 4. Index aortic segment TBR (IAS-TBR) was designated as the aortic segment with the highest TBR.
There was no significant difference in aortic F-FDG PET/CT uptake between patients and controls (GLA-TBR: 1.46 [1.40-1.57] vs. 1.43 [1.32-1.70], respectively, P = 0.422 and IAS-TBR: 1.60 [1.50-1.67] vs. 1.50 [1.42-1.61], respectively, P = 0.155). There was a moderate correlation between aortic TBR values (both GLA and IAS) and time distance from admission to F-FDG PET-CT scan (Spearman's rho = - 0.528, P = 0.017 and Spearman's rho = - 0.480, p = 0.032, respectively). Patients who were scanned less than or equal to 60 days from admission (n = 11) had significantly higher GLA-TBR values compared to patients that were examined more than 60 days post-admission (GLA-TBR: 1.53 [1.42-1.60] vs. 1.40 [1.33-1.45], respectively, P = 0.016 and IAS-TBR: 1.64 [1.51-1.74] vs. 1.52 [1.46-1.60], respectively, P = 0.038). There was a significant difference in IAS- TBR between patients scanned ≤ 60 days and controls (1.64 [1.51-1.74] vs. 1.50 [1.41-1.61], P = 0.036).
This is the first study suggesting that aortic inflammation, as assessed by F-FDG PET/CT imaging, is increased in the early post COVID phase in patients with severe or critical COVID-19 and largely resolves over time. Our findings may have important implications for the understanding of the course of the disease and for improving our preventive and therapeutic strategies.
动脉受累与 2019 年冠状病毒病（COVID-19）有关。氟 18-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）成像对于评估主动脉炎症是一种有价值的工具，也是预后的预测指标。我们旨在前瞻性评估 COVID-19 患者主动脉炎症的存在及其时间依赖性趋势。
在这项前瞻性病例对照研究中，我们于 2020 年 11 月至 2021 年 5 月期间招募了 20 名患有严重或危重症 COVID-19 的患者（平均年龄 59±12 岁），同时招募了 10 名年龄和性别匹配的个体作为对照组。通过对入院后 20-120 天进行的 PET/CT 测量 F-FDG 摄取来评估主动脉炎症。主动脉整体靶区与背景比（GLA-TBR）定义为升主动脉和降主动脉、主动脉弓和腹主动脉的 TBR 总和除以 4。主动脉节段 TBR（IAS-TBR）被指定为 TBR 最高的主动脉节段。
患者与对照组之间的主动脉 F-FDG PET/CT 摄取无显著差异（GLA-TBR：1.46[1.40-1.57]与 1.43[1.32-1.70]，P=0.422 和 IAS-TBR：1.60[1.50-1.67]与 1.50[1.42-1.61]，P=0.155）。主动脉 TBR 值（GLA 和 IAS）与从入院到 F-FDG PET-CT 扫描的时间距离之间存在中度相关性（Spearman rho=-0.528，P=0.017 和 Spearman rho=-0.480，P=0.032）。入院≤60 天进行扫描的患者（n=11）的 GLA-TBR 值明显高于入院后 60 天以上进行扫描的患者（GLA-TBR：1.53[1.42-1.60]与 1.40[1.33-1.45]，P=0.016 和 IAS-TBR：1.64[1.51-1.74]与 1.52[1.46-1.60]，P=0.038）。入院≤60 天的患者的 IAS-TBR 与对照组之间存在显著差异（1.64[1.51-1.74]与 1.50[1.41-1.61]，P=0.036）。
这是第一项表明在严重或危重症 COVID-19 患者中，主动脉炎症，如 F-FDG PET/CT 成像评估所示，在 COVID 发病后早期增加，并随时间的推移而基本消退的研究。我们的发现可能对了解疾病的过程以及改进我们的预防和治疗策略具有重要意义。
