Han Donghee, Tzolos Evangelos, Park Rebekah, Gransar Heidi, Hyun Mark, Friedman John D, Hayes Sean W, Thomson Louise E J, Kwan Alan C, Budoff Matthew, Shah Prediman K, Kwieciński Jacek, Wetzel Sarah, Findling Chloe, Slomka Piotr J, Dey Damini, Tamarappoo Balaji K, Berman Daniel S
Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
JACC Cardiovasc Imaging. 2025 May;18(5):589-599. doi: 10.1016/j.jcmg.2025.01.005. Epub 2025 Apr 2.
The effects of evolocumab on the underlying coronary disease activity by positron emission tomography (PET) and coronary tree plaque composition by coronary computed tomography angiography (CTA) have not been described.
This prospective imaging study aimed to evaluate changes in coronary plaque composition on coronary CTA and coronary microcalcification, a marker of plaque activity, on F-sodium fluoride (NaF) positron emission tomography (PET) after evolocumab treatment.
This single-arm, prospective, open-label study enrolled patients with baseline extensive noncalcified plaque volume by coronary CTA (>440 µL overall coronary artery or >250 µL in any single plaque). All participants underwent baseline and 18-month follow-up coronary CTA and F-NaF PET. Disease activity was evaluated with F-NaF PET by maximum target-to-background ratios at the lesion level and by coronary microcalcification activity for the entire coronary tree.
A total of 47 patients (age 61.8 ± 10.1 years, 87% male) and 196 lesions were studied. Twenty-three (48.9%) patients were asymptomatic, 16 (34%) presented with chest pain, and 8 (17%) presented with dyspnea. Four (8.5%) patients had a prior coronary artery disease history. At a mean follow-up of 18 months, there was no significant change in total plaque volume (716.2 ± 431.4 µL to 710.8 ± 456.2 µL, difference: 5.4 ± 97.4 µL; P = 0.705). Changes in plaque composition were observed, with a significant reduction in noncalcified plaque (607.3 ± 346.8 µL to 562.1 ± 337.3 µL, difference: 45.2 ± 63.8 µL; P < 0.001) and low-attenuation noncalcified plaque (37.1 ± 28.9 µL to 20.4 ± 15.4 µL, difference: 16.6 ± 23.5 µL; P < 0.001). In contrast, there was an increase in calcified plaque (108.9 ± 133.7 µL to 148.7 ± 175.3 µL, difference: 39.8 ± 56.1 µL; P < 0.001). There was a significant reduction in coronary microcalcification activity (1.35 ± 1.68 to 1.08 ± 1.37; P = 0.004) and lesion target-to-background ratio (1.73 ± 0.85 to 1.62 ± 0.83; P = 0.005).
In stable patients with extensive noncalcified plaque volume at baseline, 18 months of evolocumab treatment was associated with a shift toward a lower risk quantitative plaque phenotype and reduction in microcalcification activity. (Effect of Evolocumab on Coronary Atherosclerosis; NCT03689946).
依洛尤单抗对通过正电子发射断层扫描（PET）检测的潜在冠状动脉疾病活动以及通过冠状动脉计算机断层扫描血管造影（CTA）检测的冠状动脉树斑块成分的影响尚未见报道。
这项前瞻性影像学研究旨在评估依洛尤单抗治疗后，冠状动脉CTA上冠状动脉斑块成分的变化以及F-氟化钠（NaF）正电子发射断层扫描（PET）上作为斑块活动标志物的冠状动脉微钙化情况。
这项单臂、前瞻性、开放标签研究纳入了冠状动脉CTA显示基线时存在广泛非钙化斑块体积的患者（总体冠状动脉>440µL或任何单个斑块>250µL）。所有参与者均接受了基线和18个月随访的冠状动脉CTA及F-NaF PET检查。通过病变水平的最大目标与本底比值以及整个冠状动脉树的冠状动脉微钙化活性，利用F-NaF PET评估疾病活动。
共研究了47例患者（年龄61.8±10.1岁，87%为男性）及196个病变。23例（48.9%）患者无症状，16例（34%）表现为胸痛，8例（17%）表现为呼吸困难。4例（8.5%）患者有冠状动脉疾病史。平均随访18个月时，总斑块体积无显著变化（从716.2±431.4µL至710.8±456.2µL，差值：5.4±97.4µL；P=0.705）。观察到斑块成分有变化，非钙化斑块显著减少（从607.3±346.8µL至562.1±337.3µL，差值：45.2±63.8µL；P<0.001），低衰减非钙化斑块减少（从37.1±28.9µL至20.4±15.4µL，差值：16.6±23.5µL；P<0.001）。相比之下，钙化斑块增加（从108.9±133.7µL至148.7±175.3µL，差值：39.8±56.1µL；P<0.001）。冠状动脉微钙化活性显著降低（从1.35±1.68降至1.08±1.37；P=0.004），病变目标与本底比值降低（从1.73±0.85降至1.62±0.83；P=0.005）。
在基线时具有广泛非钙化斑块体积的稳定患者中，18个月的依洛尤单抗治疗与向低风险定量斑块表型的转变以及微钙化活性降低相关。（依洛尤单抗对冠状动脉粥样硬化的影响；NCT03689946）
