Pericoronary Adipose Tissue Research Articles

Pericoronary Adipose Tissue Density, Inflammation, and Subclinical Coronary Artery Disease Among People With HIV in the REPRIEVE Cohort.

Pericoronary adipose tissue (PCAT) may influence plaque development through inflammatory mechanisms. We assessed PCAT density, as a measure of pericoronary inflammation, in relationship to coronary plaque among people with human immunodeficiency virus (HIV [PWH]) and to a matched control population. In this baseline analysis of 727 participants of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) Mechanistic Substudy, we related computed tomography-derived PCAT density to presence and extent (Leaman score) of coronary artery disease (CAD), noncalcified plaque, coronary artery calcium (CAC), and vulnerable plaque features using multivariable logistic regression analyses. We further compared the PCAT density between PWH and age, sex, body mass index, CAC score, and statin use-matched controls from the community-based Framingham Heart Study (N = 464), adjusting for relevant clinical covariates. Among 727 REPRIEVE participants (age 50.8 ± 5.8 years; 83.6% [608/727] male), PCAT density was higher in those with (vs without) coronary plaque, noncalcified plaque, CAC >0, vulnerable plaque, and high CAD burden (Leaman score >5) (P < .001 for each comparison). PCAT density related to prevalent coronary plaque (adjusted odds ratio [per 10 HU]: 1.44; 95% confidence interval, 1.22-1.70; P < .001), adjusted for clinical cardiovascular risk factors, body mass index, and systemic immune/inflammatory biomarkers. Similarly, PCAT density related to CAC >0, noncalcified plaque, vulnerable plaque, and Leaman score >5 (all P ≤ .002). PCAT density was greater among REPRIEVE participants versus Framingham Heart Study (-88.2 ± 0.5 HU versus -90.6 ± 0.4 HU; P < .001). Among PWH in REPRIEVE, a large primary cardiovascular disease prevention cohort, increased PCAT density independently associated with prevalence and severity of coronary plaque, linking increased coronary inflammation to CAD in PWH.

Impact of pericoronary adipose tissue attenuation on recurrence after radiofrequency catheter ablation for atrial fibrillation.

Inflammation plays a vital role in the occurrence and progression of atrial fibrillation (AF). The association between pericoronary adipose tissue attenuation (PCATA) and AF recurrence following ablation has not been fully clarified. We aimed to evaluate the association between PCATA and AF recurrence after radiofrequency catheter ablation(RFCA). Patients who underwent the first RFCA for AF and performed coronary computed tomography angiography before ablation between 2018 and 2021 were enrolled. The predictive values of PCATA for AF recurrence after ablation were investigated. The area under curve (AUC), relative integrated discrimination improvement (IDI), and categorical free net reclassification improvement (NRI) were used to assess the discrimination ability of different models for AF recurrence. During 1-year follow-up, 34.1% patients experienced AF recurrence. The multivariable analysis model revealed that PCATA of the right coronary artery (RCA) was an independent risk factor for AF recurrence. Patients with a high level of RCA-PCATA had a high risk of recurrence, after adjusting for other risk factors by restricted cubic splines. The performance in predicting AF recurrence was significantly improved by adding the marker of RCA-PCATA to the clinical model (AUC:0.724 vs. 0.686, p = .024), with a relative IDI of 0.043 (p = .006) and continuous NRI of 0.521 (p < .001). PCATA of RCA was independently associated with AF recurrence after ablation. PCATA may be helpful for risk classification for AF ablation patients.

Semaglutide therapy decreases epicardial fat inflammation and improves psoriasis severity in patients affected by abdominal obesity and type-2 diabetes.

Psoriasis is often associated with abdominal obesity and type-2 diabetes (T2D). The inflammatory process in psoriasis can target adipose tissue depots, especially those surrounding the heart and coronary arteries, exposing to an increased risk of cardiovascular diseases. A 50-year-old female patient referred to us for abdominal obesity and T2D, which were not controlled with lifestyle modifications. She had suffered from psoriasis for some years and was treated with guselkumab, without success. Epicardial adipose tissue (EAT) attenuation and pericoronary adipose tissue (PCAT) attenuation for each coronary, defined as mean attenuation expressed in Hounsfield unit (HU), were assessed by routine coronary computed tomography angiography. At baseline, EAT attenuation was -80 HU and PCAT attenuation of the right coronary artery (RCA) was -68 HU, values associated with an increased cardiac mortality risk. Psoriasis area and severity index (PASI) was 12.0, indicating severe psoriasis, while dermatology life quality index (DLQI) was 20, indicating a negative effect on the patient's life. Semaglutide (starting with 0.25 mg/week for 4 weeks, increased to 0.50 mg/week for 16 weeks, and then to 1 mg/week) was started. After 10 months, semaglutide treatment normalized glycated hemoglobin and induced weight loss, particularly at abdominal level, also followed by a reduction in computed tomography-measured EAT volume. EAT attenuation and PCAT attenuation of RCA decreased, showing an important reduction of 17.5 and 5.9% respectively, compared with baseline. PASI and DLQI decreased by 98.3 and 95% respectively, indicating an improvement in psoriasis skin lesions and an important amelioration of the patient's quality of life, compared with baseline. Psoriasis patients affected by obesity and type-2 diabetes (T2D) are often resistant to biologic therapies. Psoriasis is often associated with abdominal obesity, T2D, and cardiovascular diseases (CVD), given their shared inflammatory properties and pathogenic similarities. Epicardial adipose tissue (EAT) inflammation can cause the distinctive pattern of CVD seen in psoriasis. EAT and pericoronary adipose tissue (PCAT) attenuation, assessed by routine coronary computed tomography angiography (CCTA), can be used as biomarkers of inflammation and allow monitoring of medical anti-inflammatory therapies. The actions of semaglutide to reduce energy intake, improve glycemic control, and produce effective weight loss, particularly at the visceral fat depot level, can diminish adipose tissue dysfunction, reduce EAT attenuation and PCAT attenuation of the right coronary artery (RCA) and concomitantly ameliorate the clinical severity of psoriasis. Semaglutide therapy may be considered in psoriasis patients affected by T2D and abdominal obesity, despite low cardiovascular risk by traditional risk scores, who are resistant to biologic therapies.

Model development and validation of noninvasive parameters based on coronary computed tomography angiography to predict culprit lesions in acute coronary syndromes within 3 years: value of plaque characteristics, hemodynamics and pericoronary adipose tissue.

Machine learning (ML) is combined with noninvasive parameters from coronary computed tomography angiography (CTA) to construct predictive models to identify culprit lesions that may lead to acute coronary syndrome (ACS). We retrospectively analyzed 132 patients with ACS at the Fourth Affiliated Hospital of Harbin Medical University who had coronary CTA between 3 months and 3 years before the ACS event, with a total of 240 lesions. Lesions from 2020 (n=154) were included in the training set, and lesions from 2021 (n=86) were included in the test set for internal validation. We evaluated the role of plaque characteristics, hemodynamic parameters and pericoronary adipose tissue (PCAT) attenuation from CTA in identifying culprit ACS lesions. In the training set, logistic regression was used to screen CTA-derived parameters with P values <0.05 for the model construction. Logistic regression, random forest, Bayesian and K-nearest neighbor algorithms were used to build classification models, and their performance was assessed using the test set. The following models were established to evaluate the effectiveness of different combinations of models to identify culprit lesions: Model 1 was established for plaque characteristics; Model 2 was established for hemodynamic parameters; Model 3 was established for PCAT attenuation; Model 4 was established for plaque characteristics and hemodynamic parameters; and Model 5 was established for plaque characteristics, hemodynamic parameters and PCAT attenuation. A total of ten high-risk factors were screened for the ML model construction, and the ML model based on the logistic regression algorithm had the best performance among the four algorithms (accuracy =0.721; sensitivity =0.892; specificity =0.592; positive prediction =0.623; and negative prediction =0.879). In this model, the minimum lumen area, positive remodeling and lesion-specific fat attenuation index (FAI) were the risk factors significantly associated with the culprit lesion. Analysis of the effect of different combinations of models to identify culprit lesions showed that Model 5 had the best predictive effect (AUC =0.819 and 95% CI: 0.722-0.916). ACS can be predicted using ML based on CTA parameters. Compared to other models, the model combining plaque characteristics, hemodynamic parameters and PCAT attenuation performed best in predicting the culprit lesion.

Radiomics Analysis Of Sex-specific Differences In Pericoronary Adipose Tissue Extracted From Coronary Ct Angiography

Radiomics Analysis Of Sex-specific Differences In Pericoronary Adipose Tissue Extracted From Coronary Ct Angiography

Coronary Artery Volume/Myocardial Mass Ratio, Epicardial and Pericoronary Adipose Tissue Volume Assessed on Computed Tomography Coronary Angiography is Associated With Index of Microcirculatory Resistance (IMR)

Coronary Artery Volume/Myocardial Mass Ratio, Epicardial and Pericoronary Adipose Tissue Volume Assessed on Computed Tomography Coronary Angiography is Associated With Index of Microcirculatory Resistance (IMR)

Effect of Statin Therapy on Coronary Inflammation Assessed by Pericoronary Adipose Tissue Computed Tomography Attenuation: Insights From the Multicentre Observational Study

Effect of Statin Therapy on Coronary Inflammation Assessed by Pericoronary Adipose Tissue Computed Tomography Attenuation: Insights From the Multicentre Observational Study

Lack of Incremental Prognostic Value of Pericoronary Adipose Tissue Computed Tomography Attenuation Beyond Coronary Artery Disease Reporting and Data System for Major Adverse Cardiovascular Events in Patients With Acute Chest Pain.

Pericoronary adipose tissue (PCAT) and Coronary Artery Disease Reporting and Data System (CAD-RADS) category had prognostic values for major adverse cardiovascular events (MACEs). However, little is known about the difference between CAD-RADS and PCAT computed tomography (CT) attenuation for predicting MACEs. This study was to compare the prognostic value of PCAT and CAD-RADS for MACEs in patients with acute chest pain. Between January 2010 and December 2021, all consecutive emergency patients with acute chest pain referred for coronary computed tomography angiography were enrolled in this retrospective study. MACEs included unstable angina requiring hospitalization, coronary revascularization, nonfatal myocardial infarction, and all-cause death. Patients' clinical characteristics, CAD-RADS, and PCAT CT attenuation were used to evaluate risk factors of MACEs using multivariable Cox regression analysis. A total of 1313 patients were evaluated (mean age, 57.13±12.57 years; 782 men). During a median follow-up of 38 months, 142 of the 1313 patients (10.81%) experienced MACEs. Multivariable Cox regression analysis showed that CAD-RADS categories 2, 3, 4, 5 (hazard ratio range, 2.286-8.325; all P<0.005) and right coronary artery PCAT CT attenuation (hazard ratio, 1.033; P=0.006) were independent predictors of MACEs after adjusting for clinical risk factors. The C statistics revealed that CAD-RADS improved risk stratification compared with PCAT CT alone (C-index, 0.760 versus 0.712; P=0.036). However, the benefit of right coronary artery PCAT CT attenuation combined with CAD-RADS was not significant compared with CAD-RADS alone (0.777 versus 0.760; P=0.129). Right coronary artery PCAT CT attenuation and CAD-RADS were independent predictors of MACEs. However, no incremental prognostic value of right coronary artery PCAT CT attenuation beyond CAD-RADS was detected for MACEs in patients with acute chest pain.

Characterization of plaque phenotypes exhibiting an elevated pericoronary adipose tissue attenuation: insights from the REASSURE-NIRS registry.

Inflammation has been considered to promote atheroma instability. Coronary computed tomography angiography (CCTA) visualizes pericoronary adipose tissue (PCAT) attenuation, which reflects coronary artery inflammation. While PCAT attenuation has been reported to predict future coronary events, plaque phenotypes exhibiting high PCAT attenuation remains to be fully elucidated. The current study aims to characterize coronary atheroma with a greater vascular inflammation. We retrospectively analyzed culprit lesions in 69 CAD patients receiving PCI from the REASSURE-NIRS registry (NCT04864171). Culprit lesions were evaluated by both CCTA and near-infrared spectroscopy/intravascular ultrasound (NIRS/IVUS) imaging prior to PCI. PCAT attenuation at proximal RCA (PCATRCA) and NIRS/IVUS-derived plaque measures were compared in patients with PCATRCA attenuation ≥ and < -78.3 HU (median). Lesions with PCATRCA attenuation ≥ -78.3 HU exhibited a greater frequency of maxLCBI4mm ≥ 400 (66% vs. 26%, p < 0.01), plaque burden ≥ 70% (94% vs. 74%, p = 0.02) and spotty calcification (49% vs. 6%, p < 0.01). Whereas positive remodeling (63% vs. 41%, p = 0.07) did not differ between two groups. On multivariable analysis, maxLCBI4mm ≥ 400 (OR = 4.07; 95%CI 1.12-14.74, p = 0.03), plaque burden ≥ 70% (OR = 7.87; 95%CI 1.01-61.26, p = 0.04), and spotty calcification (OR = 14.33; 95%CI 2.37-86.73, p < 0.01) independently predicted high PCATRCA attenuation. Of note, while the presence of only one plaque feature did not necessarily elevate PCATRCA attenuation (p = 0.22), lesions harboring two or more features were significantly associated with higher PCATRCA attenuation. More vulnerable plaque phenotypes were observed in patients with high PCATRCA attenuation. Our findings suggest PCATRCA attenuation as the presence of profound disease substrate, which potentially benefits from anti-inflammatory agents.

Exploring pericoronary adipose tissue differences between calcified and non-calcified plaques on coronary CT angiography with fat attenuation index and radiomics analysis

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology. Introduction Coronary CT angiography (CCTA)-derived pericoronary adipose tissue (PCAT) is a novel marker for coronary inflammation. The relationship between the extravascular PCAT and the vascular lesion itself is particularly important to establish its use in monitoring the disease status. Past studies investigated lesion-level PCAT differences in vessels with acute myocardial infarction. However, lesion-level PCAT differences between calcified and non-calcified plaques in patients with stable coronary artery disease were not well understood. Purpose To investigate the differences between PCAT adjacent to calcified and PCAT adjacent to non-calcified plaques using fat attenuation index (FAI) and radiomics analysis. Material and Methods In a cohort of 100 consecutive patients who underwent CCTA, 446 plaques were identified in 89 patients. Among these plaques, 213 were calcified plaques and 49 were non-calcified plaques, with the rest classified as mixed by our expert cardiologist and radiologist. The PCAT of these 262 plaques were then extracted. Following prior literature, adipose tissue was defined as voxels with attenuation ranging −190 to −30 HU. PCAT was extracted within 3 mm distance from the vessel wall, along the middle 10 mm of each plaque. FAI was defined as the mean attenuation of the PCAT volume. For radiomics analysis, we used PyRadiomics to calculate the radiomic features and the random forest classifier from Scikit-Learn to distinguish PCAT volumes of calcified and non-calcified plaques. Patient-level 5-fold cross validation was used to develop the classifier. Result FAI were higher in PCAT adjacent to non-calcified plaques compared to PCAT adjacent to calcified plaques (−81.4 [IQR: −91.8 to −73.5] vs −86.7 [IQR: −94.1 to −78.4], p = 0.008). The classifier using radiomics features achieved better discrimination (AUROC=0.738 [0.715–0.761]) than FAI alone (AUROC=0.607 [0.605–0.609]). Conclusion Significant differences in PCAT characteristics were found between calcified and non-calcified plaques either with direct comparison of FAI or radiomics analysis. Radiomics analysis revealed further discrimination between PCAT characteristics other than FAI may exist between calcified and non-calcified plaques. It is also important to note that the FAI of calcified plaques could be affected by beam hardening. Further investigation is needed to explore the underlying cause of such differences and their clinical implications.

Regional distribution of pericoronary inflammation in post COVID-19 patients - an angio-CT study of epicardial fat attenuation

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by the George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Research Grant number 164/20/10.01.2023. Background Epicardial fat (EF) and pericoronary adipose tissue (PCAT) have been extensively studied in the last decade as markers and promotors of local coronary inflammation. Quantification of EF and PCAT via CCTA, can predict the risk of acute events across various cardiovascular disorders, and has been linked to markers of local or systemic inflammation. Mapping the fat attenuation index (FAI) on routine CCTA can detect coronary artery inflammation at different levels of the coronary tree. Objectives This study aimed to evaluate the regional differences between left and right coronary inflammation in patients who had CCTA examinations for chest pain in the early stages after COVID-19 infection COVID-19 infection, using the AI-powered CaRi-Heart® medical software. Methods In this study, we included 172 patients (mean age: 62.43 ± 11.62 years) with chest pain and low to intermediate clinical likelihood of CAD, who underwent 128-slice CCTA to assess coronary anatomy, atherosclerosis, and FAI – Score determination. The study population was divided into two groups: Group 1 (n = 80) – with COVID-19 infection 2–3 months prior to their CCTA examination, Group 2 (n = 92) – adjusted for age and gender, without COVID-19 infection. For each patient, we recorded and analyzed demographic and clinical characteristics, cardiovascular risk factors, and the onset of signs and symptoms before the CCTA examination. Results The FAI - Score was considerably higher in the non COVID-19 group: LAD (11.87 ± 8.23 vs. 9.12 ± 6.20, p = 0.05), LCX (13.02 ± 6.76 vs. 10.77 ± 6.13, p = 0.05), RCA (15.88 ± 10.36 vs. 14.74 ± 12.24, p = ns), the average FAI - Score (13.23 ± 8.92 vs. 10.34 ± 7.22, p = 0.001). Comparing the FAI - Score between the left and right coronary artery, we found that for the entire study population, the FAI score was significantly higher at the RCA level (15.23 ± 11.97 vs. 11.21 ± 6.98, p = 0.02), and this difference was also maintained in the COVID-19 positive group (14.54 ± 12.17 vs. 9.77 ± 5.94, p = 0.0002), but not in the non-COVID-19 group (14.20 ± 10.78 vs. 12.88 ± 7.41, p = ns). In both groups, the CaRi Heart® Risk (p &amp;lt; 0.0001) and Duke Score (p &amp;lt; 0.0001) were significantly higher for the COVID-negative patients. Conclusions COVID-19 infection is associated with a higher risk of coronary plaque destabilization, as shown by increased inflammation in the PCAT. For the entire study population, the FAI - Score was significantly higher at the RCA level, the difference being driven by the increased RCA inflammation in the post-COVID group. This indicates a potential role of local hemorheological factors in the complex process of inflammation-mediated plaque vulnerabilization.

Increased risk of coronary plaque vulnerabilization following COVID-19 infection, identified by elevated FAI index of pericoronary inflammation at coronary CT

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This research has been funded by the research grant Intel-FAT, proposal registration code PN-III-P4-ID-PCE-2020-2861, contract number PCE 206/2021, Project funded by the European Union and the Government of Romania through the Ministry of European Funds, and the Doctoral School of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania. Background Inflammation plays an essential role in all stages of atherosclerosis, with stable plaques characterized by chronic inflammation and vulnerable or ruptured plaques exhibiting "active" inflammation. COVID infection may significantly increase systemic inflammation, but the role of SARS COV-2 infection on local plaque vulnerability is still not elucidated. Mapping the PCAT - FAI on routine CCTA can detect coronary artery inflammation non-invasively by measuring changes in the composition of pericoronary fat. Purpose The aim of this study was to assess the impact of COVID-19 infection on CAD in patients who underwent CCTA examinations for chest pain in the early stages after infection, using the new AI - powered CaRi-Heart® solution. Methods In our study, we included 158 patients (mean age was 61.63 ± 10.14 years) with chest pain and low to intermediate clinical likelihood of CAD, who underwent 128-slice CCTA for assessment of coronary anatomy, atherosclerosis, and determination of FAI – Score. The study population was divided into two main groups: Group 1 (n = 75) – patients who had a COVID-19 infection a few months prior to their CCTA examination, and Group 2 (n = 83) – patients adjusted for age and gender, who did not have a COVID-19 infection. Results The FAI - Score was consistently higher in the non COVID-19 group: LAD (11.61 ± 7.60 vs. 9.32 ± 6.00, p = 0.05), LCX (12.43 ± 6.65 vs. 10.48 ± 6.24, p = 0.05), RCA (15.40 ± 11.36 vs. 14.54 ± 12.17, p = ns), the average FAI - Score (12.81 ± 8.28 vs. 10.47 ± 7.19, p = 0.001). For the FAI-Score Centile, the overall pattern shifts significantly, as the values for all three coronary arteries are higher for the subjects in the COVID-19 positive group, as follows: LAD (0.66 ± 0.29 vs. 0.58 ± 0.28, p = 0.05), LCX (0.79 ± 0.16 vs. 0.68 ± 0.26, p = 0.03), RCA (0.83 ± 0.20 vs. 0.68 ± 0.29, p = 0.05). In both cases, the CaRi Heart® Risk (p &amp;lt; 0.0001) and the Duke Score (p &amp;lt; 0.0001) had significantly higher values for the patients in the COVID-negative group. Conclusion Lesions with higher pericoronary FAI - Score Centile values were more commonly found in patients who had previously been infected with COVID-19. The higher levels of inflammation in the pericoronary adipose tissue suggests that COVID-19 infection is linked to an increased risk of coronary plaque destabilization.

Pericoronary adipose tissue density is increased in patients with recent spontaneous coronary dissection

ObjectiveInflammatory activity is one of the potential mechanisms of spontaneous coronary artery dissection (SCAD). Recently, the pericoronary adipose tissue attenuation (PCAT) derived from CT angiography (CTA) has been established as...

Diagnostic Performance of Machine Learning-Derived Radiomics Signature of Pericoronary Adipose Tissue in Coronary Computed Tomography Angiography for Coronary Artery In-Stent Restenosis

Coronary inflammation can alter the perivascular fat phenotype. Hence, we aimed to assess the diagnostic performance of radiomics features of pericoronary adipose tissue (PCAT) in coronary computed tomography angiography (CCTA) for in-stent restenosis (ISR) after percutaneous coronary intervention. In this study, 165 patients with 214 eligible vessels were included, and ISR was found in 79 vessels. After evaluating clinical and stent characteristics, peri-stent fat attenuation index, and PCAT volume, 1688 radiomics features were extracted from each peri-stent PCAT segmentation. The eligible vessels were randomly categorized into training and validation groups in a ratio of 7:3. After performing feature selection using Pearson's correlation, F test, and least absolute shrinkage and selection operator analysis, radiomics models and integrated models that combined selected clinical features and Radscore were established using five different machine learning algorithms (logistic regression, support vector machine, random forest, stochastic gradient descent, and XGBoost). Subgroup analysis was performed using the same method for patients with stent diameters of ≤3mm. Nine significant radiomics features were selected, and the areas under the curves (AUCs) for the radiomics model and the integrated model were 0.69 and 0.79, respectively, for the validation group. The AUCs of the subgroup radiomics model based on 15 selected radiomics features and the subgroup integrated model were 0.82 and 0.85, respectively, for the validation group, which showed better diagnostic performance. CCTA-based radiomics signature of PCAT has the potential to identify coronary artery ISR without additional costs or radiation exposure.

Identification of patients with acute coronary syndrome and representation of their degree of inflammation: application of pericoronary adipose tissue within different radial distances of the proximal coronary arteries.

Pericoronary adipose tissue (PCAT) around the proximal right coronary artery (RCA) is considered a marker of coronary inflammation. We aimed to explore the segments of PCAT that represent coronary inflammation in patients with acute coronary syndrome (ACS) and to identify patients with ACS and stable coronary artery disease (CAD) prior to intervention. We retrospectively enrolled consecutive patients with ACS and stable CAD who underwent invasive coronary angiography (ICA) after coronary computed tomography angiography (CCTA) from November 2020 to October 2021 at the Fourth Affiliated Hospital of Harbin Medical University. The fat attenuation index (FAI) was obtained using PCAT quantitative measurement software, and the coronary Gensini score was also calculated to indicate the severity of CAD. The differences and correlations between FAI within different radial distances of proximal coronary arteries were evaluated, and the recognition ability of FAI for patients with ACS and stable CAD was evaluated by establishing receiver operator characteristic (ROC) curves. A total of 267 patients were included in the cross-sectional study, including 173 patients with ACS. With the increase of radial distance from the outer wall of proximal coronary vessels, the FAI decreased (P<0.001). The FAI around the proximal left anterior descending artery (LAD) within the reference diameter from the outer wall of the vessel (LADref) had the highest correlation with the FAI around culprit lesions [r=0.587; 95% confidence interval (CI): 0.489-0.671; P<0.001]. The model based on clinical features, Gensini score, and LADref had the highest recognition performance for patients with ACS and stable CAD [area under the curve (AUC): 0.663; 95% CI: 0.540-0.785]. LADref is most correlated with FAI around culprit lesions in patients with ACS and has higher value in the preintervention differentiation of patients with ACS and stable CAD compared to the use of clinical features alone.

Association of perivascular fat attenuation on computed tomography and heart failure with preserved ejection fraction.

Heart failure with a preserved ejection fraction (HFpEF) is associated with chronic inflammation. We aimed to investigate the association between pericoronary adipose tissue attenuation (PCATA) on coronary computed tomography angiography as a novel noninvasive marker of pericoronary inflammation and the presence of HFpEF. This retrospective study included 607 outpatients (median age, 65years; 50% male) who underwent both echocardiography and coronary computed tomography angiography. Patients with obstructive coronary artery disease were excluded from this study. PCATA was compared between patients with and without HFpEF, which was diagnosed according to the Heart Failure Association (HFA)-PEFF score. PCATA was assessed at the proximal 40-mm segments of all three major coronary arteries on coronary computed tomography angiography. Patients with HFpEF had higher PCATA in all coronary arteries compared to the control participants: left anterior descending artery (LAD), -65.2±6.9 Hounsfield units (HU) vs. -68.1±6.7 HU; left circumflex artery (LCX), -62.7±6.8 HU vs. -65.4±6.6 HU; and right coronary artery (RCA), -63.6±8.5 HU vs. -65.5±7.7 HU (P<0.01). Multivariate logistic regression analysis, including conventional risk factors, revealed that PCATA per standard deviation in the LAD (odds ratio [OR], 1.449; 95% confidence interval [CI], 1.152-1.823), LCX (OR, 1.634; 95% CI, 1.283-2.081), and RCA (OR, 1.388; 95% CI, 1.107-1.740) were independently associated with HFpEF. The association between PCATA and HFpEF was mostly consistent across various patient clinical characteristics. The left ventricular mass and left atrial volume index showed a mild correlation with LAD-PCATA (ρ=0.13 [P<0.01] and ρ=0.24 [P<0.01]) and LCX-PCATA (ρ=0.16 [P<0.01] and ρ=0.23 [P<0.01]). High PCATA score was significantly associated with the presence of HFpEF. Our results suggest that inflammation in the pericoronary artery adipose tissue is one of the underlying mechanisms of HFpEF.

Relationship of OCT-defined plaque characteristics with CCTA-derived coronary inflammation and CMR-derived global coronary flow reserve in patients with acute coronary syndrome.

The relationship of layered plaque detected by optical coherence tomography (OCT) with coronary inflammation and coronary flow reserve (CFR) remains elusive. We aimed to investigate the association of OCT-defined layered plaque with pericoronary adipose tissue (PCAT) inflammation assessed by coronary computed tomography angiography (CCTA) and global (G)-CFR assessed by cardiac magnetic resonance imaging (CMR) in patients with acute coronary syndrome (ACS). We retrospectively investigated 88 patients with first ACS who underwent preprocedural CCTA, OCT imaging of the culprit lesion prior to primary/urgent percutaneous coronary intervention (PCI), and postprocedural CMR. All patients were divided into two groups according to the presence and absence of OCT-defined layered plaque at the culprit lesion. Coronary inflammation was assessed by the mean value of PCAT attenuation (-190 to -30 HU) of the three major coronary vessels. G-CFR was obtained by quantifying absolute coronary sinus flow at rest and during maximum hyperemia. CCTA and CMR findings were compared between the groups. In a total of 88 patients, layered plaque was detected in 51 patients (58.0%). The patients with layered plaque had higher three-vessel-PCAT attenuation value (-68.58 ± 6.41 vs. -71.60 ± 5.21 HU, P = 0.021) and culprit vessel-PCAT attenuation value (-67.69 ± 7.76 vs. -72.07 ± 6.57 HU, P = 0.007) than those with non-layered plaque. The patients with layered plaque had lower G-CFR value (median, 2.26 [interquartile range, 1.78, 2.89] vs. 3.06 [2.41, 3.90], P = 0.003) than those with non-layered plaque. The presence of OCT-defined layered plaque at the culprit lesion was associated with high PCAT attenuation and low G-CFR after primary/urgent PCI in patients with ACS. OCT assessment of culprit plaque morphology and detection of layered plaque may help identify increased pericoronary inflammation and impaired CFR, potentially providing the risk stratification in patients with ACS and residual microvascular dysfunction after PCI.

Computed tomography-based pericoronary adipose tissue attenuation in patients undergoing TAVR: a novel method for risk assessment.

This study aims to assess the attenuation of pericoronary adipose tissue (PCAT) surrounding the proximal right coronary artery (RCA) in patients with aortic stenosis (AS) and undergoing transcatheter aortic valve replacement (TAVR). RCA PCAT attenuation is a novel computed tomography (CT)-based marker for evaluating coronary inflammation. Coronary artery disease (CAD) in TAVR patients is common and usually evaluated prior to intervention. The most sensible screening method and consequential treatment approach are unclear and remain a matter of ceaseless discussion. Thus, interest remains for safe and low-demand predictive markers to identify patients at risk for adverse outcomes postaortic valve replacement. This single-center retrospective study included patients receiving a standard planning CT scan prior to TAVR. Conventional CAD diagnostic tools, such as coronary artery calcium score and significant stenosis via invasive coronary angiography and coronary computed tomography angiography, were determined in addition to RCA PCAT attenuation using semiautomated software. These were assessed for their relationship with major adverse cardiovascular events (MACE) during a 24-month follow-up period. From a total of 62 patients (mean age: 82 ± 6.7 years), 15 (24.2%) patients experienced an event within the observation period, 10 of which were attributed to cardiovascular death. The mean RCA PCAT attenuation was higher in patients enduring MACE than that in those without an endpoint (-69.8 ± 7.5 vs. -74.6 ± 6.2, P = 0.02). Using a predefined cutoff of >-70.5 HU, 20 patients (32.3%) with high RCA PCAT attenuation were identified, nine (45%) of which met the endpoint within 2 years after TAVR. In a multivariate Cox regression model including conventional CAD diagnostic tools, RCA PCAT attenuation prevailed as the only marker with significant association with MACE (P = 0.02). After dichotomization of patients into high- and low-RCA PCAT attenuation groups, high attenuation was related to greater risk of MACE (hazard ration: 3.82, P = 0.011). RCA PCAT attenuation appears to have predictive value also in a setting of concomitant AS in patients receiving TAVR. RCA PCAT attenuation was more reliable than conventional CAD diagnostic tools in identifying patients at risk for MACE .

Evolocumab attenuate pericoronary adipose tissue density via reduction of lipoprotein(a) in type 2 diabetes mellitus: a serial follow-up CCTA study

BackgroundPericoronary adipose tissue (PCAT) density is a biomarker of vessel inflammation, which is supposed to be increased in patients with type 2 diabetes mellitus (T2DM). However, whether the coronary inflammation revealed by this novel index could be alleviated after evolocumab treatment in T2DM remains unknown.MethodsFrom January 2020 to December 2022, consecutive T2DM patients with low-density lipoprotein cholesterol ≥ 70 mg/dL on maximally tolerated statin and taking evolocumab were prospectively included. In addition, patients with T2DM who were taking statin alone were recruited as control group. The eligible patients underwent baseline and follow-up coronary CT angiography with an interval of 48-week. To render patients with evolocumab as comparable to those controls, a propensity-score matching design was used to select the matched pairs with a 1:1 ratio. Obstructive lesion was defined as the extent of coronary artery stenosis ≥ 50%; the numbers inside the brackets were interquartile ranges.ResultsA total of 170 T2DM patients with stable chest pain were included [(mean age 64 ± 10.6 [range 40–85] years; 131 men). Among those patients, 85 were in evolocumab group and 85 were in control group. During follow-up, low-density lipoprotein cholesterol (LDL-C) level (2.02 [1.26, 2.78] vs. 3.34 [2.53, 4.14], p < 0.001), and lipoprotein(a) (12.1 [5.6, 21.8] vs. 18.9 [13.2, 27.2], p = 0.002) were reduced after evolocumab treatment. The prevalence of obstructive lesions and high-risk plaque features were significantly decreased (p < 0.05 for all). Furthermore, the calcified plaque volume were significantly increased (188.3 [115.7, 361.0] vs. 129.3 [59.5, 238.3], p = 0.015), while the noncalcified plaque volume and necrotic volume were diminished (107.5 [40.6, 180.6] vs. 125.0 [65.3, 269.7], p = 0.038; 0 [0, 4.7] vs. 0 [0, 13.4], p < 0.001, respectively). In addition, PCAT density of right coronary artery was significantly attenuated in evolocumab group (− 85.0 [− 89.0, − 82.0] vs. − 79.0 [− 83.5, − 74.0], p < 0.001). The change in the calcified plaque volume inversely correlated with achieved LDL-C level (r = − 0.31, p < 0.001) and lipoprotein(a) level (r = − 0.33, p < 0.001). Both the changes of noncalcified plaque volume and necrotic volume were positively correlated with achieved LDL-C level and Lp(a) (p < 0.001 for all). However, the change of PCATRCA density only positively correlated with achieved lipoprotein(a) level (r = 0.51, p < 0.001). Causal mediation analysis revealed Lp(a) level mediated 69.8% (p < 0.001) for the relationship between evolocumab and changes of PCATRCA.ConclusionsIn patients with T2DM, evolocumab is an effective therapy to decrease noncalcified plaque volume necrotic volume, and increase calcified plaque volume. Furthermore, evolocumab could attenuate PCAT density, at least in part, via the reduction of lipoprotein(a).

P154 HUMAN CORONARY INFLAMMATION AT CORONARY COMPUTED TOMOGRAPHY IN PATIENTS WITH INOCA

Abstract Background A new imaging metric using coronary computed tomography angiography (CCTA), addressing the peri–coronary adipose tissue (PCAT) computed tomography (CT) attenuation, has been clinically validated. This method provides information regarding coronary inflammation. It is unclear how coronary inflammation affects microvascular function. The non–invasive evaluation of coronary flowvelocity reserve is widely used in clinical practice using Doppler measurement on the left anterior descending coronary artery (CFVR–lad) during stress–echocardiography (SE).We hypothesize that coronary inflammation affects CFVR–lad and, in the absence of overt CAD, they are significantly correlated. Methods We evaluated the relationship between coronary inflammation (by PCAT CT attenuation) and coronary microvascular function (by CFVR–lad) in subjects with no or non–obstructive (diameter stenosis &amp;lt;70%) coronary artery disease (CAD). Results Two–hundred and two subjects were enrolled in the study. The relationship between PCAT CT attenuation and CFVR–lad show a significant inverse relationship in the entire group of subjects enrolled in the study (r = −0.32, p &amp;lt; 0.001). Correlation between PCAT CT attenuation and CFVR–lad was significant in subjects with no or mild CAD–lad, while this was not the case in subjects with intermediate CAD–lad. The R and R2 were respectively −0.40, −0.16 in subjects without CAD (p &amp;lt; 0.001) and − 0.35 and − 0.12 in subjects with mild CAD–lad (p = 0.001). Conclusions The main finding of the current study is the independent relationship between coronarymicrovascular function, by Doppler CFVR–lad during SE, in subjectswithout severely obstructive CAD in the left anterior descending coronary artery, and the level of local coronary inflammation, by PCAT attenuation measurement on CCTA.