Background and Aims Chronic stress associates with cardiovascular disease, but mechanisms remain incompletely defined. Advanced imaging was used to identify stress-related neural imaging phenotypes associated with atherosclerosis. Methods Twenty-seven individuals with post-traumatic stress disorder (PTSD), 45 trauma-exposed controls without PTSD, and 22 healthy controls underwent 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI). Atherosclerotic inflammation and burden were assessed using 18F-FDG PET (as maximal target-to-background ratio, TBR max) and MRI, respectively. Inflammation was assessed using high-sensitivity C-reactive protein (hsCRP) and leucopoietic imaging (18F-FDG PET uptake in spleen and bone marrow). Stress-associated neural network activity (SNA) was assessed on 18F-FDG PET as amygdala relative to ventromedial prefrontal cortex (vmPFC) activity. MRI diffusion tensor imaging assessed the axonal integrity (AI) of the uncinate fasciculus (major white matter tract connecting vmPFC and amygdala). Results Median age was 37 years old and 54% of participants were female. There were no significant differences in atherosclerotic inflammation between participants with PTSD and controls; adjusted mean difference in TBR max (95% confidence interval) of the aorta 0.020 (−0.098, 0.138), and of the carotids 0.014 (−0.091, 0.119). Participants with PTSD had higher hsCRP, spleen activity, and aorta atherosclerotic burden (normalized wall index). Participants with PTSD also had higher SNA and lower AI. Across the cohort, carotid atherosclerotic burden (standard deviation of wall thickness) associated positively with SNA and negatively with AI independent of Framingham risk score. Conclusions In this study of limited size, participants with PTSD did not have higher atherosclerotic inflammation than controls. Notably, impaired cortico-limbic interactions (higher amygdala relative to vmPFC activity or disruption of their intercommunication) associated with carotid atherosclerotic burden. Larger studies are needed to refine these findings.

中文翻译：

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慢性应激暴露期间皮质-边缘相互作用和颈动脉粥样硬化负担


背景和目标 慢性压力与心血管疾病相关，但其机制仍不完全明确。先进成像用于识别与动脉粥样硬化相关的压力相关神经成像表型。方法 27 名患有创伤后应激障碍 (PTSD) 的个体、45 名无 PTSD 的创伤暴露对照者和 22 名健康对照者接受 18F-氟脱氧葡萄糖正电子发射断层扫描/磁共振成像 (18F-FDG PET/MRI)。分别使用 18F-FDG PET（最大目标与背景比，TBR max）和 MRI 评估动脉粥样硬化炎症和负荷。使用高敏 C 反应蛋白 (hsCRP) 和白细胞生成成像（脾脏和骨髓中的 18F-FDG PET 摄取）评估炎症。压力相关神经网络活动 (SNA) 在 18F-FDG PET 上评估为杏仁核相对于腹内侧前额皮质 (vmPFC) 的活动。 MRI 扩散张量成像评估了钩束（连接 vmPFC 和杏仁核的主要白质束）的轴突完整性 (AI)。结果 参与者的中位年龄为 37 岁，54% 为女性。患有 PTSD 的参与者和对照组之间的动脉粥样硬化炎症没有显着差异；主动脉 TBR max（95% 置信区间）的调整平均差为 0.020（−0.098，0.138），颈动脉为 0.014（−0.091，0.119）。患有 PTSD 的参与者具有较高的 hsCRP、脾脏活动和主动脉粥样硬化负荷（标准化壁指数）。患有 PTSD 的参与者也有较高的 SNA 和较低的 AI。在整个队列中，颈动脉粥样硬化负荷（壁厚度的标准差）与 SNA 呈正相关，与 AI 呈负相关，与 Framingham 风险评分无关。 结论 在这项规模有限的研究中，患有 PTSD 的参与者并没有比对照组有更高的动脉粥样硬化炎症。值得注意的是，皮质边缘相互作用受损（杏仁核相对于 vmPFC 活动较高或相互通讯中断）与颈动脉粥样硬化负担相关。需要更大规模的研究来完善这些发现。