BackgroundAlthough epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD), it is unclear whether EAT volume (EAV) can be used to diagnose high-risk coronary plaque burden associated with coronary events. This study aimed to investigate (1) the prognostic impact of low-attenuation non-calcified coronary plaque (LAP) burden on patient level analysis, and (2) the association of EAV with LAP volume in patients without known CAD undergoing coronary computed tomography angiography (CCTA).Materials and MethodsThis retrospective study consisted of 376 patients (male, 57%; mean age, 65.2 ± 13 years) without known CAD undergoing CCTA. Percent LAP volume (%LAP, <30 HU) was calculated as the LAP volume divided by the vessel volume. EAT was defined as adipose tissue with a CT attenuation value ranging from −250 to −30 HU within the pericardial sac. The primary endpoint was a composite event of death, non-fatal myocardial infarction, and unstable angina and worsening symptoms requiring unplanned coronary revascularization >3 months after CCTA. The determinants of %LAP (Q4) were analyzed using a multivariable logistic regression model.ResultsDuring the follow-up period (mean, 2.2 ± 0.9 years), the primary endpoint was observed in 17 patients (4.5%). The independent predictors of the primary endpoint were %LAP (Q4) (hazard ratio [HR], 3.05; 95% confidence interval [CI], 1.09–8.54; p = 0.033] in the Cox proportional hazard model adjusted by CAD-RADS category. Cox proportional hazard ratio analysis demonstrated that %LAP (Q4) was a predictor of the primary endpoint, independnet of CAD severity, Suita score, EAV, or CACS. The independent determinants of %LAP (Q4) were CACS ≥218.3 (p < 0.0001) and EAV ≥125.3 ml (p < 0.0001). The addition of EAV to CACS significantly improved the area under the curve (AUC) to identify %LAP (Q4) than CACS alone (AUC, EAV + CACS vs. CACS alone: 0.728 vs. 0.637; p = 0.013).ConclusionsCCTA-based assessment of EAV, CACS, and LAP could help improve personalized cardiac risk management by administering patient-suited therapy.

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Background Wide-volume scanning with 320row multidetector computed tomography coronary angiography (CTCA-WVS) enables the assessment of the aortic arch plaque (AAP) morphology and coronary arteries without requiring additional contrast volume. This study aimed to investigate the prevalence of AAPs and their association with coronary artery disease (CAD) and major adverse cardiovascular events (MACEs) in patients who underwent CTCA-WVS. MethodsThis study included 204 patients without known CAD (mean age, 65 years; 53% men) who underwent CTCA-WVS. We evaluated the presence of aortic plaques in the ascending aorta, aortic arch, and thoracic descending aorta using CTCA-WVS. Large aortic plaques were defined as plaques of at least 4 mm in thickness. A complex aortic plaque was defined as a plaque with ulceration or protrusion. MACEs were defined as composite events of cardiovascular (CV) death, nonfatal myocardial infarction, and ischemic stroke. ResultsAAPs and large/complex AAPs were identified in 51% (n = 105) and 18% (n = 36) of the study patients, respectively. The prevalence of AAPs with large/complex morphology increased with CAD severity (2.1% in no CAD, 12% in nonobstructive CAD, and 39% in obstructive CAD). The univariate Cox hazard model demonstrated that the predictors associated with MACEs were diabetes, obstructive CAD, and large/complex AAPs. Independent factors associated with large/complex AAPs were male sex [odds ratio (OR), 2.90; P = 0.025], stroke history (OR, 3.48; P = 0.026), obstructive CAD (OR, 3.35; P = 0.011), and thoracic aortic calcification (OR, 1.77; P = 0.005). ConclusionCTCA-WVS provides a comprehensive assessment of coronary atherosclerosis and thoracic aortic plaques in patients with CAD, which may improve the stratification of patients at risk for CV events.

BackgroundThis study aimed to investigate the association between diabetes mellitus (DM), high-risk coronary plaque burden, and risk of cardiovascular outcomes across metabolic phenotypes in patients with suspected coronary artery disease (CAD) who underwent coronary computed tomography angiography (CCTA).MethodsWe included 530 patients who underwent CCTA. Metabolic syndrome (MetS) was defined as the presence of a visceral adipose tissue area ≥ 100 cm2in patients with DM (n = 58), or two or more MetS components excluding DM (n = 114). Remaining patients were categorized into non-MetS patients with DM (n = 52) and non-MetS patients without DM (n = 306). CCTA-based high-risk plaque was defined as low-attenuation plaque (LAP) volume > 4 %. Primary endpoint was presence of a major cardiovascular event (MACE), which was defined as a composite of cardiovascular death, acute coronary syndrome, and coronary revascularization.ResultsIncidence of MACE was highest in the non-MetS with DM group, followed hierarchically by the MetS with DM, MetS without DM, and non-MetS without DM groups. In the multivariable Cox hazard model analysis, DM as a predictor was associated with MACE independent of LAP volume > 4 % (hazard ratio, 2.68; 95% confidence interval, 1.16–6.18; p = 0.02), although MetS did not remain an independent predictor. LAP volume > 4 % remained a predictor of MACE independent of each metabolic phenotype or DM.ConclusionsThis study demonstrated that DM, rather than MetS, is a predictor of coronary events independent of high-risk plaque volume in patients who underwent CCTA.Clinical PerspectiveWhat Is New?This study investigated the association between diabetes mellitus (DM), high-risk coronary plaque burden, and major adverse cardiovascular events (MACE) across metabolic phenotypes stratified by the presence or absence of metabolic syndrome (MetS) and DM in patients with suspected coronary artery disease (CAD) who underwent coronary computed tomography angiography (CCTA).Among the four metabolic phenotypes, incidence of MACE was highest in the non-MetS with DM group, followed hierarchically by the MetS with DM, MetS without DM, and non-MetS without DM groups. Low-attenuation coronary plaque (LAP) volume > 4% was a robust predictor of MACE among the metabolic phenotypes. Furthermore, DM, independent of LAP volume > 4%, was a predictor of MACE, while MetS did not show a significant predictive value.What Are the Clinical Implications?Our results demonstrate that individuals with DM alone have a significantly higher risk of developing cardiovascular events than those with MetS, indicating that DM is an independent predictor of cardiovascular events irrespective of the presence of obstructive CAD or LAP volume greater than 4%.