Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Imaging plaque inflammation in asymptomatic cocaine addicted individuals with simultaneous positron emission tomography/magnetic resonance imaging
Keren Bachi, Venkatesh Mani, Audrey E Kaufman, Nadia Alie, Rita Z Goldstein, Zahi A Fayad, Nelly Alia-Klein
Keren Bachi, Rita Z Goldstein, Nelly Alia-Klein, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
Keren Bachi, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
Venkatesh Mani, Audrey E Kaufman, Nadia Alie, Zahi A Fayad, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
Nadia Alie, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
Rita Z Goldstein, Nelly Alia-Klein, Department of Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States
Author contributions: Mani V, Goldstein RZ, Fayad ZA and Alia-Klein N designed the research; Bachi K reviewed literature and collected drug use data; Mani V and Fayad ZA performed vascular imaging; Mani V, Kaufman AE and Alie N analyzed imaging data; Bachi K performed statistical analyses; Bachi K, Mani V, Goldstein RZ, Fayad ZA and Alia-Klein N provided interpretation; Mani V, Kaufman AE, Goldstein RZ and Fayad ZA provided commentary and manuscript editing; and Bachi K and Alia-Klein N wrote the paper.
Supported by NIDA, No. K23DA045928-01 (to Bachi K) and No. R01DA041528 (to Goldstein RZ); NIH/NHLBI, No. R01 HL071021; Translational and Molecular Imaging Institute internal funding (to Fayad ZAF); and American Heart Association Grant in Aid, No. 17GRNT33420119 (to Mani VM).
Institutional review board statement: The study protocol was reviewed and conducted with approval by the Institutional Review Board of the Icahn School of Medicine at Mount Sinai (Study ID: GCO#01-1032).
Informed consent statement: All participants in the study cohort have signed an informed consent form prior to study enrollment as required by the Institutional Review Board of the Icahn School of Medicine at Mount Sinai.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Nelly Alia-Klein, PhD, Associate Professor, Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave Levy, 1470 Madison Ave., New York, NY 10029, United States. nelly.alia-klein@mssm.edu
Telephone: +1-212-8249311
Received: February 16, 2019
Peer-review started: February 18, 2019
First decision: March 15, 2019
Revised: April 5, 2019
Accepted: May 21, 2019
Article in press: May 22, 2019
Published online: May 28, 2019
BACKGROUND
Chronic cocaine use is associated with stroke, coronary artery disease and myocardial infarction, resulting in severe impairments or sudden mortality. In the absence of clear cardiovascular symptoms, individuals with cocaine use disorder (iCUD) seeking addiction treatment receive mostly psychotherapy and psychiatric pharmacotherapy, with no attention to vascular disease (i.e., atherosclerosis). Little is known about the pre-clinical signs of cardiovascular risk in iCUD and early signs of vascular disease are undetected in this underserved population.
AIM
To assess inflammation, plaque burden and plaque composition in iCUD aiming to detect markers of atherosclerosis and vascular disease.
METHODS
The bilateral carotid arteries were imaged with positron emission tomography/magnetic resonance imaging (PET/MRI) in iCUD asymptomatic for cardiovascular disease, healthy controls, and individuals with cardiovascular risk. PET with 18F-fluorodeoxyglucose (18F-FDG) evaluated vascular inflammation and 3-D dark-blood MRI assessed plaque burden including wall area and thickness. Drug use and severity of addiction were assessed with standardized instruments.
RESULTS
The majority of iCUD and controls had carotid FDG-PET signal greater than 1.6 but lower than 3, indicating the presence of mild to moderate inflammation. However, the MRI measure of wall structure was thicker in iCUD as compared to the controls and cardiovascular risk group, indicating greater carotid plaque burden. iCUD had larger wall area as compared to the healthy controls but not as compared to the cardiovascular risk group, indicating structural wall similarities between the non-control study groups. In iCUD, wall area correlated with greater cocaine withdrawal and craving.
CONCLUSION
These preliminary results show markers of carotid artery disease burden in cardiovascular disease-asymptomatic iCUD. Broader trials are warranted to develop protocols for early detection of cardiovascular risk and preventive intervention in iCUD.
Core tip: Despite undetected clinical signs, cocaine use increases risk of stroke, coronary artery disease and myocardial infarction. Simultaneous carotid positron emission tomography/magnetic resonance imaging can effectively evaluate vascular inflammation and plaque burden in individuals with cocaine use disorder. Cocaine users had increased wall area, comparable to individuals with cardiovascular risk and significantly higher than healthy controls. Wall area in cocaine users positively correlated with greater cocaine withdrawal and craving. Broader trials are warranted to develop protocols for early detection of cardiovascular risk and preventive intervention in individuals with cocaine use disorder.
