Improvement in Aortic Vascular Inflammation by PET/CT Associates with Improvement in Aortic Distensibility by MRI at One-Year in Psoriasis Open Access

Introduction: Globally, 18 million people die from cardiovascular disease (CVD) annually, making it the leading cause of morbidity and mortality worldwide. In recent years, inflammation has been established as a key cause of CVD, but the effects of anti-inflammatory treatment on cardiovascular (CV) risk remains poorly understood. Psoriasis (PSO), a chronic inflammatory skin disease associated with increased CV events, provides an ideal clinical model to study inflammation and CV risk. Cardiovascular inflammation can be monitored by PET/CT of the aorta. Aortic distensibility (AD) is an important marker of subclinical CVD and has been shown to predict future CV events. Following subclinical markers, such as AD, enables physicians to make judicious treatment decisions before events such as stroke, myocardial infarction, or angina occur. Our study demonstrates a novel association between VI and AD in patients with chronic inflammatory disease. Hypothesis: A reduction in aortic vascular inflammation (VI), measured by PET/CT, will associate with increased AD, measured by PET-MRI at 1-year. Methods: Consecutively recruited PSO patients (N=50) underwent whole-body PET/CT scans to quantify VI as target-to-background ratio (TBR). Descending aorta contours on PET-MRI were traced throughout the cardiac cycle [Qflow, Medis] to measure AD. Longitudinal changes in aortic VI and AD were analyzed by multivariable regression. Results: The cohort was middle aged (mean ± SEM: 49.8 ±1.9 years), mostly male (56%), had low CVD risk, and mild-to-moderate PSO. At 1-year follow up, patients had a median improvement in PSO severity of 40% (p<0.001) with use of biological therapy (28/50 patients) while aortic VI decreased by 8% (1.81 ± 0.05 vs 1.67 ± 0.04, p<0.001) and AD increased by 10% (0.61 ± 0.03 vs 0.67 ± 0.04, p=0.04). Reduction in aortic VI was associated with an improvement in AD beyond traditional CV risk factors, statin use, and systemic/biologic PSO therapy (β=-0.36, p=0.04). Conclusion: Improvement in aortic VI in patients with psoriasis by PET/CT is associated with improvement in AD by PET-MRI at 1-year, suggesting that treatment of inflammation may have a favorable impact on functional characteristics of the aorta. These findings further advance our understanding of the role of inflammation in CVD and the utility of PET-MRI for inflammatory CVD risk prediction. Our novel findings can help improve the accuracy of CVD risk prediction, enable physicians to make evidence-based decisions, and decrease the global economic burden of cardiovascular disease on healthcare systems.

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