Coronary Artery Disease and Pericoronary Adipose Tissue Attenuation by Computed Tomography in Familial Hypercholesterolemia

Abstract

Introduction: Familial hypercholesterolaemia (FH) is a common hereditary lipid disorder which causes premature coronary artery disease. Pericoronary adipose tissue (PCAT) attenuation is a novel computed tomography coronary angiography (CTCA) biomarker of coronary inflammation with prognostic validation. We sought to compare PCAT attenuation in FH patients with and without significant coronary artery disease (CAD). Methods: Patients with probable/definite FH as per Dutch Lipid Clinical Network Criteria who underwent 320-detector CTCA were included in this cross-sectional study. More than 50% coronary stenoses in CTCA were defined as significant CAD. Using semi-automated software (Autoplaque version 2.0), PCAT attenuation was measured around the proximal 10–50 mm of the right coronary artery (RCA). In patients with significant CAD, PCAT attenuation was measured around the lesion with highest-grade stenosis. Results: Sixty patients with phenotypic FH (40 with significant CAD and 20 with no CAD) were included. Median low-density lipoprotein cholesterol (LDL-C) was higher in patients without CAD compared to those with significant CAD (5.3 [IQR 3.85–6.7] vs. 3.3 [2.65–4.55] mmol/L, p < 0.001]. PCAT attenuation was significantly higher in patients with significant CAD compared to those without CAD (−80.9 ± 12.2 vs. −90.6 ± 7.6 HU, p = 0.004). PCAT attenuation around the proximal RCA was not statistically significant between the two groups (−85.3 ± 11.9 vs. −90.6 ± 7.6, p = 0.09). PCAT attenuation did not correlate with plasma LDL-C levels. Conclusion: FH patients with significant CAD had a higher PCAT attenuation than those without CAD, perhaps reflecting a greater degree of coronary inflammation. Future studies are required to assess whether PCAT attenuation can enhance risk stratification and guide therapy in FH patients.