Physiological significance of pericoronary inflammation in epicardial functional stenosis and global coronary flow reserve

Yoshihisa Kanaji,Tsunekazu Kakuta,Hidenori Hirano,Masahiro Hoshino,Kai Nogami,Masahiro Hada,Tomoyo Sugiyama,Masao Yamaguchi,Rikuta Hamaya,Tatsuhiro Nagamine,Hiroki Ueno,Taishi Yonetsu,Toru Misawa,Yumi Yasui,Tetsuo Sasano,Eisuke Usui

doi:10.1038/s41598-021-97849-5

Yoshihisa Kanaji, Tsunekazu Kakuta + Show 14 more

Open Access

https://doi.org/10.1038/s41598-021-97849-5

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Abstract

Both fractional flow reserve (FFR) and global coronary flow reserve (g-CFR) provide prognostic information in patients with stable coronary artery disease (CAD). Inflammation plays a vital role in impaired endothelial dysfunction and atherosclerotic progression, potentially predicting cardiovascular mortality. This study aimed to evaluate the physiological significance of pericoronary adipose tissue inflammation assessed by CT attenuation (PCATA) in epicardial functional stenosis severity and g-CFR in patients with CAD. A total of 131 CAD patients with a single de novo epicardial coronary stenosis who underwent coronary CT-angiography (CCTA), phase-contrast cine-magnetic resonance imaging (PC-CMR) and FFR measurement were studied. PCATA was assessed using the mean CT attenuation value. G-CFR was obtained by quantifying absolute coronary sinus flow (ml/min/g) by PC-CMR at rest and during maximum hyperemia. Median FFR, g-CFR, and PCATA values were 0.75, 2.59, and − 71.3, respectively. Serum creatinine, NT-proBNP, left ventricular end-diastolic volume, and PCATA were independently associated with g-CFR. PCATA showed a significant incremental predictive efficacy for impaired g-CFR (< 2.0) when added to the clinical risk model. PCATA was significantly associated with g-CFR, independent of FFR. Our results suggest the pathophysiological mechanisms linking perivascular inflammation with g-CFR in CAD patients.

Highlights

Both fractional flow reserve (FFR) and global coronary flow reserve (g-CFR) provide prognostic information in patients with stable coronary artery disease (CAD)
Phase-contrast cine-magnetic resonance imaging (PC-CMR) allows non-invasive quantification of myocardial blood flow (MBF) and g-CFR by quantifying coronary sinus flow (CSF) without need for ionizing radiation, radioactive tracers, gadolinium, or intravascular catheterization, which have been validated against P ET10,11
Mean PCATA of 3 major vessels and target vessel PCATA were higher in the group with impaired g-CFR compared with those without (P < 0.001, P = 0.003, respectively)

Summary

Introduction

Both fractional flow reserve (FFR) and global coronary flow reserve (g-CFR) provide prognostic information in patients with stable coronary artery disease (CAD). This study aimed to evaluate the physiological significance of pericoronary adipose tissue inflammation assessed by CT attenuation (PCATA) in epicardial functional stenosis severity and g-CFR in patients with CAD. We further evaluated if PCATA showed the incremental discriminatory efficacy to predict impaired g-CFR when added to the prediction model including FFR. To test this hypothesis, the present study was undertaken by measuring FFR, g-CFR, and PCATA in CAD patients with a single epicardial de novo lesion and preserved systolic function

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