High risk coronary plaque
A multimodality approach combining CT, OCT, IVUS, PET and histology with information on inflammation and shear stress has identified “high risk” coronary plaques that are at risk for rupture. Current efforts focus on whether this high risk CT phenotype can identify the patients at greatest risk for cardiovascular events.

  1. Bittner Daniel O., Mayrhofer Thomas, Puchner Stefan B., Lu Michael T., Maurovich-Horvat Pal, Ghemigian Khristine, Kitslaar Pieter H., Broersen Alexander, Bamberg Fabian, Truong Quynh A., Schlett Christopher L., Hoffmann Udo, Ferencik Maros. Coronary Computed Tomography Angiography–Specific Definitions of High-Risk Plaque Features Improve Detection of Acute Coronary Syndrome. Circ Cardiovasc Imaging American Heart Association; 2018;11:e007657.
  2. Puchner SB, Lu MT, Mayrhofer T, Liu T, Pursnani A, Ghoshhajra BB, Truong QA, Wiviott SD, Fleg JL, Hoffmann U, Ferencik M. High-Risk Coronary Plaque at Coronary CT Angiography Is Associated with Nonalcoholic Fatty Liver Disease, Independent of Coronary Plaque and Stenosis Burden: Results from the ROMICAT II Trial. Radiology 2015;274:693–701.
  3. Puchner SB, Liu T, Mayrhofer T, Truong QA, Lee H, Fleg JL, Nagurney JT, Udelson JE, Hoffmann U, Ferencik M. High-Risk Plaque Detected on Coronary CT Angiography Predicts Acute Coronary Syndromes Independent of Significant Stenosis in Acute Chest Pain: Results From the ROMICAT-II Trial. J Am Coll Cardiol 2014;64:684–692.

Amygdalar, arterial, and bone-marrow uptake of F-FDG in individuals with and without subsequent cardiovascular disease events.

Axial views of amygdala (upper left and right), coronal views of aorta (middle left and right), and coronal views of bone marrow (lower left and right) are shown. .⁸F-FDG uptake was increased in the amygdala, bone marrow, and arterial wall (aorta), in a patient who experienced an ischemic stroke during the follow-up period (right) compared with a patient who did not (left). .⁸F-FDG=.⁸F fluorodeoxyglucose. SUV=standardised uptake value. TBR=target-to-background ratio. Tawakol et al Lancet 2017.

In this first study to link regional brain activity to subsequent cardiovascular disease, amygdalar activity independently and robustly predicted cardiovascular disease events. Amygdalar activity is involved partly via a path that includes increased bone-marrow activity and arterial inflammation. These findings provide novel insights into the mechanism through which emotional stressors can lead to cardiovascular disease in human beings.

  1. Tawakol Ahmed, Osborne Michael T., Wang Ying, Hammed Basma, Tung Brian, Patrich Tomas, Oberfeld Blake, Ishai Amorina, Shin Lisa M., Nahrendorf Matthias, Warner Erica T., Wasfy Jason, Fayad Zahi A., Koenen Karestan, Ridker Paul M, Pitman Roger K., Armstrong Katrina A. Stress-Associated Neurobiological Pathway Linking Socioeconomic Disparities to Cardiovascular Disease. J Am Coll Cardiol American College of Cardiology Foundation; 2019;73:3243–3255.
  2. Tawakol A, Ishai A, Li D, Takx RAP, Hur S, Kaiser Y, Pampaloni M, Rupert A, Hsu D, Sereti I, Fromentin R, Chomont N, Ganz P, Deeks SG, Hsue PY. Association of Arterial and Lymph Node Inflammation With Distinct Inflammatory Pathways in Human Immunodeficiency Virus Infection. JAMA Cardiol 2017;2:163–171.
  3. Tawakol A, Ishai A, Takx RA, Figueroa AL, Ali A, Kaiser Y, Truong QA, Solomon CJ, Calcagno C, Mani V, Tang CY, Mulder WJ, Murrough JW, Hoffmann U, Nahrendorf M, Shin LM, Fayad ZA, Pitman RK. Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study. The Lancet 2017;389:834–845.

Coronary plaque and arterial inflammation in HIV
Multi-modal, multi-tissue imaging provides a unique opportunity to evaluate pathological disorders that involve multiple tissues and organs. One recent example of such imaging is in the evaluation of mechanisms linking HIV infection to atherosclerosis. Studies from our group demonstrated that the increased risk of cardiovascular events in HIV may be due to increased arterial inflammation on PET and coronary plaque on CT. Several on-going RCTs are assessing the impact of complementary therapies on arterial inflammation on PET and atherosclerotic plaque structure on CT in HIV.

  1. Foldyna B, Fourman LT, Lu MT, Mueller ME, Szilveszter B, Neilan TG, Ho JE, Burdo TH, Lau ES, Stone LA, Toribio M, Srinivasa S, Looby SE, Lo J, Fitch KV, Zanni MV. Sex Differences in Subclinical Coronary Atherosclerotic Plaque Among Individuals With HIV on Antiretroviral Therapy. J Acquir Immune Defic Syndr 1999 2018;78:421–428.
  2. Zanni MV, Abbara S, Lo J, Wai B, Hark D, Marmarelis E, Grinspoon SK. Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men. AIDS Lond Engl 2013;27:1263–1272.