Brain Emotional Neural Activity is Associated With Complex Plaque Characteristics Resulting Acute Plaque Instability: A Prospective 3D-Rendered 18F FDG-PET/CT Assessment

초록

Introduction: Stress-associated neurobiological activity is associated with future cardiovascular events. However, whether the linkage between brain emotional activity and complex plaque characteristics exists during the phase of acute plaque instability needs to be elucidated. Objectives: We aimed to prospectively estimate brain amygdalar activity (AmygA), arterial inflammation (AI) and macrophage hematopoiesis (HEMA) according to the presence of complex plaque characteristics in patients with acute myocardial infarction (AMI). Methods: In a total of 45 AMI patients (mean 60.0 years, 84.4% male), 18F FDG-PET/CT imaging was performed within 45 days of index episode. Total plaque burden was assessed using the SYNTAX score. The culprit plaque was considered complex, if there were two or more of the following morphologic features: thrombus, ulceration, plaque irregularity, and impaired flow (TIMI<3). The PET signal activities were compared using a customized 3D-rendered PET/CT reconstruction. Results: Average SYNTAX score ranged by 16.3±8.4 and 12 (26.7%) patients had intermediate to high score (≥22). Complex culprit plaque and significant flow limitation were present in 34 (75.6%) and 33 (73.3%) patients, respectively. AmygA increased significantly in those who had higher SYNTAX score (≥22; target-to-background ratio [TBR]: 0.68±0.08 vs. 0.63±0.06; p=0.004), complex culprit plaques (TBR: 0.66±0.05 vs. 0.60±0.04; p<0.001), and significant flow limitation (TBR: 0.66±0.05 vs. 0.61±0.06; p=0.008) as compared to those without complex features (Figure). In contrast, carotid AI, aortic AI, and HEMA merely showed significant differences according to the presence of the aforementioned complex angiographic characteristics. Conclusions: AmygA was markedly enhanced in AMI patients with complex plaque characteristics. These findings suggest that AmygA closely associates with loco-regional disease activity at the level of coronary vasculature.