Stratification Of Diseases Research Articles

Abstract 9862: Correlation of Lipoprotein(a) and Plaque Morphology in Very Young Acute Coronary Syndrome Patients Using Optical Coherence Tomography

Background: Levels of lipoprotein (Lp) (a) are a useful marker for risk stratification of cardiovascular diseases. This genetic biomarker is suggestive of patient predisposition to an acute coronary event. Its correlation with the plaque morphology is yet to be explored with optical coherence tomography (OCT). Aim: To study the correlation of Lp(a) levels and plaque morphology in very young (<35 years) patients presenting with acute coronary syndrome(ACS). Methods: A prospective, single-centre, observational study was conducted at a tertiary-care centre. Very young patients with acute coronary syndrome and fit for OCT guided invasive coronary angiography were included. Lp(a) levels were compared between healthy controls and these very young ACS patients. Correlation of Lp(a) levels and plaque characteristics in very young ACS patients was done using OCT imaging. Results: A total of 80 subjects were enrolled in the study. Out of these 40 were very young ACS and 40 were age matched healthy controls. Mean levels of Lp(a) were 28.10±13.96 nmol/l and 61.20±55.88 nmol/l in healthy controls and very young patients with ACS respectively (p=0.022). In very young patients, plaque rupture and erosion were the mechanism of acute coronary syndrome in 67.5% and 32.5% patients, respectively. Among very young ACS patients, those with Lp(a) levels <75 nmol/l had a mean thin cap fibroatheroma thickness of 96.89±65.52 μm and those with Lp(a) levels ≥75 nmol/l had a mean thin cap fibroatheroma thickness of 67.85±53.80 μm (p=0.158). Conclusion: It was revealed that patients with higher Lp(a) levels had lesser thickness of fibrous cap on OCT imaging compared with lower levels of Lp(a). Lp(a) levels were independently associated with ACS in very young (<35 years) patients, with plaque rupture being the commonest mechanism. Hence, we conclude that higher Lp(a) levels predispose to ACS at a very young age associated with lowering of fibrous cap thickness.

Chip-Based Sensing of the Intercellular Transfer of Cell Surface Proteins: Regulation by the Metabolic State.

Glycosylphosphatidylinositol (GPI)-anchored proteins (GPI-APs) are anchored at the surface of mammalian blood and tissue cells through a carboxy-terminal GPI glycolipid. Eventually, they are released into incubation medium in vitro and blood in vivo and subsequently inserted into neighboring cells, potentially leading to inappropriate surface expression or lysis. To obtain first insight into the potential (patho)physiological relevance of intercellular GPI-AP transfer and its biochemical characterization, a cell-free chip- and microfluidic channel-based sensing system was introduced. For this, rat or human adipocyte or erythrocyte plasma membranes (PM) were covalently captured by the TiO2 chip surface operating as the acceptor PM. To measure transfer between PM, donor erythrocyte or adipocyte PM were injected into the channels of a flow chamber, incubated, and washed out, and the type and amount of proteins which had been transferred to acceptor PM evaluated with specific antibodies. Antibody binding was detected as phase shift of horizontal surface acoustic waves propagating over the chip surface. Time- and temperature-dependent transfer, which did not rely on fusion of donor and acceptor PM, was detected for GPI-APs, but not typical transmembrane proteins. Transfer of GPI-APs was found to be prevented by α-toxin, which binds to the glycan core of GPI anchors, and serum proteins in concentration-dependent fashion. Blockade of transfer, which was restored by synthetic phosphoinositolglycans mimicking the glycan core of GPI anchors, led to accumulation in the chip channels of full-length GPI-APs in association with phospholipids and cholesterol in non-membrane structures. Strikingly, efficacy of transfer between adipocytes and erythrocytes was determined by the metabolic state (genotype and feeding state) of the rats, which were used as source for the PM and sera, with upregulation in obese and diabetic rats and counterbalance by serum proteins. The novel chip-based sensing system for GPI-AP transfer may be useful for the prediction and stratification of metabolic diseases as well as elucidation of the putative role of intercellular transfer of cell surface proteins, such as GPI-APs, in (patho)physiological mechanisms.

The Comparison of Imaging and Clinical Methods to Estimate Prostate Volume: A Single-Centre Retrospective Study

Background: Prostate volume (PV) is a useful tool in risk stratification, diagnosis, and follow-up of numerous prostatic diseases including prostate cancer and benign prostatic hypertrophy. There is currently no accepted ideal PV measurement method. Objective: This study compares multiple means of PV estimation, including digital rectal examination (DRE), transrectal ultrasound (TRUS), and magnetic resonance imaging (MRI), and radical prostatectomy specimens to determine the best volume measurement style. Methods: A retrospective, observational, single-site study with patients identified using an institutional database was performed. A total of 197 patients who underwent robot-assisted radical prostatectomy were considered. Data collected included age, serum PSA at the time of the prostate biopsy, clinical T stage, Gleason score, and PVs for each of the following methods: DRE, TRUS, MRI, and surgical specimen weight (SPW) and volume. Results: A paired t test was performed, which reported a statistically significant difference between PV measures (DRE, TRUS, MRI ellipsoid, MRI bullet, SP ellipsoid, and SP bullet) and the actual prostate weight. Lowest differences were reported for SP ellipsoid volume (M = −2.37; standard deviation [SD] = 10.227; t[167] = −3.011; and p = 0.003), MRI ellipsoid volume (M = −4.318; SD = 9.53; t[167] = −5.87; and p = 0.000), and MRI bullet volume (M = 5.31; SD = 10.77; t[167] = 6.387; and p = 0.000). Conclusion: The PV obtained by MRI has proven to correlate with the PV obtained via auto-segmentation software as well as actual SPW, while also being more cost-effective and time-efficient. Therefore, demonstrating that MRI estimated the PV is an adequate method for use in clinical practice for therapeutic planning and patient follow-up.

A Novel Approach For Diagnosis Of Dermatologic Diseases Based On Multi-Objective Clustering Using Particle Swarm Optimization

The stratification of skin diseases plays a major role in enabling effective and customized medicine. An important task in the stratification of skin diseases is to discover subtypes of diseases for effective treatment. To achieve this goal, research into cluster algorithms for the stratification of skin diseases has attracted the attention of both scholars and the medical community in recent decades. However, cluster algorithms suffer from realistic limitations such as experimental sounds, high dimension and poor interpretation. In particular, cluster algorithms usually determine the quality of clusters with only one internal evaluation operation. Unfortunately, it is obvious that one internal evaluation operation is difficult to create and strong for all datasets. Therefore, this article proposes a novel of many descriptive frameworks called a multi objective cluster algorithm with a quick search and finding the density of peaks to deal with these limitations altogether. In the proposed framework, the variable component of the candidate is developed under many objectives to select properties and estimate the density of the cluster automatically. To guide the development of multi-objective, two cluster value indices are used, including the Calinski-Harabasz index and the Davies-Bouldin index. The clustering is performed with the help of a k-means cluster by finding the best clusters using particle optimization. PSO will solve the multi-objective to determine the best cluster. Here, the proposed method will test on the dermatology dataset from UCI repository using MATLAB R2020a, under windows10 environment. Then, the proposed method performance will be evaluating using the cluster evaluation indices.

Machine Learning and Syncope Management in the ED: The Future Is Coming.

In recent years, machine learning (ML) has been promisingly applied in many fields of clinical medicine, both for diagnosis and prognosis prediction. Aims of this narrative review were to summarize the basic concepts of ML applied to clinical medicine and explore its main applications in the emergency department (ED) setting, with a particular focus on syncope management. Through an extensive literature search in PubMed and Embase, we found increasing evidence suggesting that the use of ML algorithms can improve ED triage, diagnosis, and risk stratification of many diseases. However, the lacks of external validation and reliable diagnostic standards currently limit their implementation in clinical practice. Syncope represents a challenging problem for the emergency physician both because its diagnosis is not supported by specific tests and the available prognostic tools proved to be inefficient. ML algorithms have the potential to overcome these limitations and, in the future, they could support the clinician in managing syncope patients more efficiently. However, at present only few studies have addressed this issue, albeit with encouraging results.

Interaction of Full-Length Glycosylphosphatidylinositol-Anchored Proteins with Serum Proteins and Their Translocation to Cells In Vitro Depend on the (Pre-)Diabetic State in Rats and Humans.

Glycosylphosphatidylinositol (GPI)-anchored proteins (GPI-APs), which are anchored at the surface of mammalian cultured and tissue cells through a carboxy-terminal GPI glycolipid, are susceptible to release into incubation medium and (rat and human) blood, respectively, in response to metabolic stress and ageing. Those GPI-APs with the complete GPI still attached form micelle-like complexes together with (lyso)phospholipids and cholesterol and are prone to degradation by serum GPI-specific phospholipase D (GPLD1), as well as translocation to the surface of acceptor cells in vitro. In this study, the interaction of GPI-APs with GPLD1 or other serum proteins derived from metabolically deranged rat and humans and their translocation were measured by microfluidic chip- and surface acoustic wave-based sensing of micelle-like complexes reconstituted with model GPI-APs. The effect of GPI-AP translocation on the integrity of the acceptor cell surface was studied as lactate dehydrogenase release. For both rats and humans, the dependence of serum GPLD1 activity on the hyperglycemic/hyperinsulinemic state was found to be primarily based on upregulation of the interaction of GPLD1 with micelle-like GPI-AP complexes, rather than on its amount. In addition to GPLD1, other serum proteins were found to interact with the GPI phosphoinositolglycan of full-length GPI-APs. Upon incubation of rat adipocytes with full-length GPI-APs, their translocation from the micelle-like complexes (and also with lower efficacy from reconstituted high-density lipoproteins and liposomes) to acceptor cells was observed, accompanied by upregulation of their lysis. Both GPI-AP translocation and adipocyte lysis became reduced in the presence of serum proteins, including (inhibited) GPLD1. The reduction was higher with serum from hyperglycemic/hyperinsulinemic rats and diabetic humans compared to healthy ones. These findings suggest that the deleterious effects of full-length GPI-APs following spontaneous release into the circulation of metabolically deranged rats and humans are counterbalanced by upregulated interaction of their GPI anchor with GPLD1 and other serum proteins. Thereby, translocation of GPI-APs to blood and tissue cells and their lysis are prevented. The identification of GPI-APs and serum proteins interacting within micelle-like complexes may facilitate the prediction and stratification of diseases that are associated with impaired cell-surface anchorage of GPI-APs, such as obesity and diabetes.

Metallofluorocarbon Nanoemulsion for Inflammatory Macrophage Detection via PET and MRI.

Inflammation is associated with a range of serious human conditions, including autoimmune and cardiovascular diseases and cancer. The ability to image active inflammatory processes greatly enhances our ability to diagnose and treat these diseases at an early stage. We describe molecular compositions enabling sensitive and precise imaging of inflammatory hotspots invivo. Methods: A functionalized nanoemulsion with a fluorocarbon-encapsulated radiometal chelate (FERM) was developed to serve as a platform for multimodal imaging probe development. The 19F-containing FERM nanoemulsion encapsulates 89Zr in the fluorous oil via a fluorinated hydroxamic acid chelate. Simple mixing of the radiometal with the preformed aqueous nanoemulsion before use yields FERM, a stable invivo cell tracer, enabling whole-body 89Zr PET and 19F MRI after a single intravenous injection. Results: The FERM nanoemulsion was intrinsically taken up by phagocytic immune cells, particularly macrophages, with high specificity. FERM stability was demonstrated by a high correlation between the 19F and 89Zr content in the blood (correlation coefficient > 0.99). Image sensitivity at a low dose (37 kBq) was observed in a rodent model of acute infection. The versatility of FERM was further demonstrated in models of inflammatory bowel disease and 4T1 tumor. Conclusion: Multimodal detection using FERM yields robust whole-body lesion detection and leverages the strengths of combined PET and 19F MRI. The FERM nanoemulsion has scalable production and is potentially useful for precise diagnosis, stratification, and treatment monitoring of inflammatory diseases.

Stratification of Chest Diseases through Convolution Neural Network

Stratification of Chest Diseases through Convolution Neural Network

New Comprehensive Reference Values for Arterial Vascular Parameters in Children

Noninvasive measurements of vascular parameters can be used for the detection and risk stratification of cardiovascular diseases. Most vascular parameters are influenced by age and body size, but pediatric reference values are scarce and limited to a few parameters. The aim of this study was to develop pediatric reference values and Z score equations for a comprehensive set of vascular parameters. A total of 292 healthy subjects aged 0 to 18years were prospectively recruited. Stiffness index β, pressure-strain elastic modulus, common carotid intima-media thickness, brachial flow-mediated dilation, radial augmentation index, central and right arm peripheral artery pulse-wave velocities, and pulse-wave velocity ratio were assessed. Normalization for age and anthropometric variables was performed using parametric multivariate regression modeling. Z scores were assessed for heteroscedasticity, residual association with age and body size, and distribution. Multivariate regression models with various combinations of height, weight, and age were used to obtain Z scores that were independent of age and body size. There was no residual association between Z scores and body size, age, or body mass index. There was no significant departure from the normal distribution. The authors present reference values and Z score equations for a comprehensive set of vascular parameters during childhood. Further studies are necessary to assess their usefulness in detecting the vascular signs of subclinical atherosclerosis and chronic diseases, including congenital heart disease.

SARS-CoV-2–Induced Immune Dysregulation and Myocardial Injury Risk in China

SARS-CoV-2–Induced Immune Dysregulation and Myocardial Injury Risk in China

Immunoglobulin A antibodies to oxidized collagen type II as a potential biomarker for the stratification of spondyloarthritis from rheumatoid arthritis

Objectives The discovery of diseased tissue-specific neoantigens offers the opportunity to develop important disease tissue-specific biomarkers that can help in the prediction, diagnosis, and stratification of diseases. This opportunity is specifically significant for autoimmune diseases where diagnostic biomarkers are not available. Inflammatory autoimmune diseases are commonly associated with local generation of large amounts of reactive oxidants. We have previously identified oxidative post-translationally modified (oxPTM) tissue-specific neoantigens in rheumatoid arthritis (RA) and type 1 diabetes that elicit an immune response. In the current study, we studied the presence and clinical significance of antibodies to oxPTM collagen type II (CII) in patients with spondyloarthritis (SpA). Method Levels of antibodies specific to native CII and oxPTM-CII were assessed by enzyme-linked immunosorbent assay. Results Immunoglobulin G (IgG) binding to oxPTM-CII was observed in 52%, 83%, and 28% of serum samples from patients with axial spondyloarthritis (axSpA), RA, and psoriatic arthritis (PsA), respectively. Importantly, while strong IgA anti-oxPTM-CII responses were detected in axSpA and PsA patients, with 47% and 84% respective binders, no IgA anti-oxPTM-CII was detected in RA patients. IgA anti-oxPTM-CII reactivity in axSpA patients treated with biologics was higher and more frequent, with 85% binders compared to 9% binders in patients treated with synthetic disease-modifying anti-rheumatic drugs. Conclusion Our data imply that SpA and PsA are associated with the presence of antibodies to oxPTM-CII, suggesting that there may be a humoral component that may distinguish patients with SpA from RA. Our approach could be adapted to other diseases, particularly to inflammatory autoimmune diseases.

The Role of Cardiovascular Magnetic Resonance in Inflammatory Arthropathies and Systemic Rheumatic Diseases

In this review, the role of cardiovascular magnetic resonance (CMR), magnetic resonance angiography (MRA) and magnetic resonance spectroscopy (MRS) in the diagnosis, risk stratification, management and prognostication of inflammatory arthropathies and systemic rheumatic diseases (IASRD) is discussed. There have been several recent publications and it is timely to place into perspective the rapidly evolving concepts of advanced imaging in IASRDs through review and critical appraisal of the literature. IASRD are multisystemic autoimmune disorders with predilection for cardiovascular involvement and complications. Persons with IASRD have increased risk of coronary artery disease, stroke, peripheral vascular disease, myocarditis, cardiomyopathy and heart failure that may not be fully explained by traditional CVD risk factors, and inflammation is presumed to be an important determinant of CVD. There is increasing evidence that lowering systemic inflammation reduces prevalence of CVD in IASRD patients. CMR is an advanced imaging modality, free of ionising radiation, with high spatial and temporal resolution, performed via excitation of atomic nuclei with uneven spin and capable of providing detailed anatomical, functional and haemodynamic information on the heart and vasculature. CMR is the single imaging modality capable of assessing noninvasively global and regional cardiac function, fibrosis, perfusion, flow, vascular function and oedema. The unique strengths of CMR are its ability to noninvasively image the entire cardiovascular tree (myocardium and vessels) with high resolution and to reveal tissue characteristics for the study of inflammation, infarction, fibrosis and infiltration. CMR combined with MRA is capable of visualising vascular complications of IASRD as well as to track disease progression or regression following therapy. MRS reported no abnormalities in IASRD on proton MRS, but impaired myocardial energetics on phosphorous MRS. CMR, MRA and MRS have significantly improved our understanding of disease mechanisms, diagnosis, risk stratification, management and prognostication of IASRD. Further CMR can be used for the study of inflammation and fibrosis and to track disease progression and regression following therapeutic interventions.

Circulating Non-coding RNAs and Cardiovascular Diseases.

The discovery of noncoding RNAs (ncRNAs) including short microRNAs, long ncRNAs and circular RNAs has broaden our knowledge about mammalian genomes and transcriptomes. A growing number of evidence on aberrantly regulated ncRNAs in cardiovascular diseases has indicated that ncRNAs are critical contributors to cardiovascular pathophysiology. Moreover, multiple recent studies have reported that ncRNAs can be detected in the bloodstream that differs between health subjects and diseased patients and some of them are remarkably stable. Although our knowledge about the origin and function of the circulating ncRNAs is still limited, these molecules have been regarded as promising noninvasive biomarker for risk stratification, diagnosis and prognosis of various cardiovascular diseases. In this chapter, we have described biological characteristics of circulating ncRNAs and discussed current trends and future prospects for the usage of circulating ncRNAs as biomarkers for common cardiovascular diseases.

EuroCMR 2019 highlights.

Cardiovascular magnetic resonance (CMR) has become one of the main imaging techniques for the diagnosis and prognostic stratification of the different cardiovascular diseases. Proof of this is the growing interest in training in this imaging technique which was evident in the past EuroCMR 2019 where 1379 specialists (26.5% more than in the previous edition) met in Lido (Venice) to discuss the latest scientific advances in the CMR field. In this review, we will discuss the most recent research presented during this congress that aroused maximum interest.

Underfilling of vacuum blood collection tubes leads to increased lactate dehydrogenase activity in serum and heparin plasma samples.

Background Lactate dehydrogenase (LD) activity is routinely monitored for therapeutic risk stratification of malignant diseases, but is also prone to preanalytical influences. Methods We systematically analyzed the impact of defined preanalytical conditions on the hemolysis-susceptible parameters LD, potassium (K) and hemolysis index in vacuum blood collection tubes (serum [SE], heparin plasma [HP]). Blood was collected by venipuncture from healthy volunteers. Tubes were either filled or underfilled to approximately 50%, then processed directly or stored at room temperature for 4 h. Potassium (K), sodium (Na), chloride (Cl), LD, creatine kinase (CK), total cholesterol, and indices for hemolysis, icterus, and lipemia were analyzed. Filling velocity was determined in a subset of tubes. Findings in healthy volunteers were reconfirmed in an in-patient cohort (n = 74,751) that was analyzed for plasma yield and LD data distribution. Results LD activity was higher in HP compared to SE. Underfilling led to higher LD values (SE: +21.6%; HP: +28.3%), K (SE: +4.2%; HP: +5.3%), and hemolysis index (SE: +260.8%; HP: +210.0%), while other analytes remained largely unchanged. Filling velocity of tubes was approximately 3-fold higher in the first half compared to the second half in both HP and SE collection tubes. Importantly, plasma yield also inversely correlated with LD in routine patients. By calculating reference limits, the lowest plasma yield quartile of the patient cohort displayed LD values clearly exceeding current reference recommendations. Conclusions Underfilling of tubes leads to a higher proportion of blood aspirated with high velocity and relevant elevations in LD. This finding should be considered in cases of clinically implausible elevated LD activities.

Symptom-based stratification of autoimmune diseases.

For many autoimmune diseases, definitions of disease and patient heterogeneity are major concerns. Response to treatment varies greatly between patients, and this variability might obstruct clinical trials. Many drug candidates have not shown efficacy in patients with systemic autoimmune diseases and thus will not reach the market, despite excellent responses in individual patients or subgroups of patients. Stratification of patients is therefore of high priority, but no validated biomarkers to define relevant subgroups of patients with primary Sjögren's syndrome exist.

Genome-Wide Analysis of Left Ventricular Image-Derived Phenotypes Identifies Fourteen Loci Associated With Cardiac Morphogenesis and Heart Failure Development.

The genetic basis of left ventricular (LV) image-derived phenotypes, which play a vital role in the diagnosis, management, and risk stratification of cardiovascular diseases, is unclear at present. The LV parameters were measured from the cardiovascular magnetic resonance studies of the UK Biobank. Genotyping was done using Affymetrix arrays, augmented by imputation. We performed genome-wide association studies of 6 LV traits-LV end-diastolic volume, LV end-systolic volume, LV stroke volume, LV ejection fraction, LV mass, and LV mass to end-diastolic volume ratio. The replication analysis was performed in the MESA study (Multi-Ethnic Study of Atherosclerosis). We identified the candidate genes at genome-wide significant loci based on the evidence from extensive bioinformatic analyses. Polygenic risk scores were constructed from the summary statistics of LV genome-wide association studies to predict the heart failure events. The study comprised 16 923 European UK Biobank participants (mean age 62.5 years; 45.8% men) without prevalent myocardial infarction or heart failure. We discovered 14 genome-wide significant loci (3 loci each for LV end-diastolic volume, LV end-systolic volume, and LV mass to end-diastolic volume ratio; 4 loci for LV ejection fraction, and 1 locus for LV mass) at a stringent P<1×10-8. Three loci were replicated at Bonferroni significance and 7 loci at nominal significance (P<0.05 with concordant direction of effect) in the MESA study (n=4383). Follow-up bioinformatic analyses identified 28 candidate genes that were enriched in the cardiac developmental pathways and regulation of the LV contractile mechanism. Eight genes (TTN, BAG3, GRK5, HSPB7, MTSS1, ALPK3, NMB, and MMP11) supported by at least 2 independent lines of in silico evidence were implicated in the cardiac morphogenesis and heart failure development. The polygenic risk scores of LV phenotypes were predictive of heart failure in a holdout UK Biobank sample of 3106 cases and 224 134 controls (odds ratio 1.41, 95% CI 1.26 - 1.58, for the top quintile versus the bottom quintile of the LV end-systolic volume risk score). We report 14 genetic loci and indicate several candidate genes that not only enhance our understanding of the genetic architecture of prognostically important LV phenotypes but also shed light on potential novel therapeutic targets for LV remodeling.

EuroCMR 2019 HIGHLIGHTS.

Cardiovascular magnetic resonance (CMR) has become one of the main imaging techniques for the diagnosis and prognostic stratification of the different cardiovascular diseases. Proof of this is the growing interest in training in this imaging technique which was evident in the past EuroCMR 2019 where 1379 specialists (26.5% more than in the previous edition) met in Lido (Venice) to discuss the latest scientific advances in the CMR field. In this review, we will discuss the most recent research presented during this congress that aroused maximum interest.

Future research trends in understanding the mechanisms underlying allergic diseases for improved patient care.

The specialties of allergy and clinical immunology have entered the era of precision medicine with the stratification of diseases into distinct disease subsets, specific diagnoses, and targeted treatment options, including biologicals and small molecules. This article reviews recent developments in research and patient care and future trends in the discipline. The section on basic mechanisms of allergic diseases summarizes the current status and defines research needs in structural biology, type 2 inflammation, immune tolerance, neuroimmune mechanisms, role of the microbiome and diet, environmental factors, and respiratory viral infections. In the section on diagnostic challenges, clinical trials, precision medicine and immune monitoring of allergic diseases, asthma, allergic and nonallergic rhinitis, and new approaches to the diagnosis and treatment of drug hypersensitivity reactions are discussed in further detail. In the third section, unmet needs and future research areas for the treatment of allergic diseases are highlighted with topics on food allergy, biologics, small molecules, and novel therapeutic concepts in allergen‐specific immunotherapy for airway disease. Unknowns and future research needs are discussed at the end of each subsection.

The role of perivascular adipose tissue in the development of cardiovascular diseases. The importance of diagnosis for assessing the risk stratification of cardiovascular diseases.

Obesity is closely associated with metabolic and cardiovascular diseases, including dyslipidemia, coronary artery disease, hypertension, and heart failure. Adipose tissue (AT) is identified as a complex endocrine organ, with a wide range of regulatory functions at the cellular, tissue and systemic levels. Various terms, including paracardiac, epicardial and pericardial, are used to describe the fatty deposits surrounding the heart. Among all the fat depots, perivascular AT (PVAT) is of great biological significance for the cardiovascular system due to its anatomical proximity to the vessels. Recent studies have shown the presence of a complex, bidirectional paracrine and vasocardial signaling system between the vascular wall and PVAT. In the review, we will discuss the biological role of PVAT in both the physiological state and cardiovascular pathology, emphasizing its dual proatherogenic and antiatherogenic role. Let us consider PVAT as a target for various therapeutic agents in cardiovascular diseases. We will also analyze data on the role of non-invasive techniques as a diagnostic tool for assessing coronary artery inflammation.