Associations between the serum triglyceride-glucose index and pericoronary adipose tissue attenuation and plaque features using dual-layer spectral detector computed tomography: a cross-sectional study

Abstract

Background and aimsThe triglyceride-glucose (TyG) index is a reliable alternative marker for insulin resistance (IR). Pericoronary adipose tissue (PCAT) can indirectly reflect coronary inflammation. IR and coronary inflammation play a key role in the development and progression of coronary atherosclerosis. Therefore, this study investigated the relationships between the TyG index, PCAT and atherosclerotic plaque characteristics to explore whether IR might lead to coronary artery atherosclerosis progression by inducing coronary inflammation.MethodsWe retrospectively collected data on patients with chest pain who underwent coronary computed tomography angiography using spectral detector computed tomography at our institution from June to December 2021. The patients were grouped based on their TyG index levels: T1 (low), T2 (medium), and T3 (high). Each patient was assessed for total plaque volume, plaque load, maximum stenosis, the plaque component volume proportion, high-risk plaques(HRPs), and plaque characteristics (including low attenuation plaques, positive remodeling, a napkin ring sign, and spot calcification). PCAT quantification was performed on the proximal right coronary artery using the fat attenuation index (FAI) measured from a conventional multicolor computed tomography image (FAI120kVp), a spectral virtual single-energy image (FAI40keV), and the slope of the spectral HU curve (λHU).ResultsWe enrolled 201 patients. The proportion of patients with maximum plaque stenosis, positive remodeling, low-density plaques, and HRPs increased as the TyG index level increased. Moreover, the FAI40keV and λHU significantly differed among the three groups, and we identified good positive correlations between FAI40keV and λHU and the TyG index (r = 0.319, P <0.01 and r = 0.325, P <0.01, respectively). FAI120kVp did not significantly differ among the groups. FAI40keV had the highest area under the curve, with an optimal cutoff value of −130.5 HU for predicting a TyG index value of ≥9.13. The multivariate linear regression analysis demonstrated that FAI40keV and λHU were independently positively related to a high TyG index level (standardized regression coefficients: 0.117 [P <0.001] and 0.134 [P <0.001], respectively).ConclusionsPatients with chest pain and a higher TyG index level were more likely to have severe stenosis and HRPs. Moreover, FAI40keV and λHU had good correlations with the serum TyG index, which may noninvasively reflect PCAT inflammation under insulin resistance. These results could help explain the mechanism of plaque progression and instability in patients with insulin resistance might be related to IR-induced coronary inflammation.

Triglyceride glucose index is associated with functional coronary artery stenosis in hypertensive patients

“…Simultaneously, our research demonstrates that individuals with an increased serum TyG index also frequently have high-risk plaques (HRPs) and typical HRPCs. This result is in line with other research (23,37), showing a relationship between plaque stability and the TyG index. Thus, we hypothesize that serum TyG index level and plaque instability may be related.…”

“…Additionally, this research also evaluated the correlation between the TyG index and adverse plaque characteristics (HRPCs) and the FAI in hypertensive patients. Damage to vascular endothelial cells brought on by IR can trigger an inflammatory reaction ( 23 ). It has been demonstrated that coronary artery inflammation inhibits fat formation in perivascular fat, thereby altering the attenuation of perivascular fat to CCTA ( 36 ).…”

“…The ‘napkin ring’ sign, which consists of a high-attenuation outer rim surrounding a low-attenuation core region ( 22 ). High-risk plaques (HRPs) were defined as those that met two or more of those criteria ( 23 ).…”

Triglyceride glucose index and renal function decline in Han Chinese hypertensive patients

“… 6 As an alternative to the conventional gold standard hyperinsulinemic‐euglycemic clamp method, the TyG index was introduced as a more simple and cost‐effective means of IR with high sensitivity (96.5%) and specificity (85%). 14 Currently, the TyG index has been extensively explored in diverse medical issues, such as cardiovascular disease, 6 , 7 , 8 , 9 arterial stiffness progression, 10 diabetic nephropathy, 11 new‐onset hypertension, 15 cardiometabolic diseases, 16 DM, 17 , 18 , 19 intensity care unit mortality, 20 obesity, 21 and hearing impairment. 22 However, there are relative few reports about TyG index and hypertensive nephropathy.…”

“…In this context, the triglyceride glucose (TyG) index has emerged as a non‐invasive and cost‐effective alternative indicator to assess IR. 5 Recent studies have shown that an elevated TyG index is associated with an increased risk of cardiovascular disease, 6 , 7 , 8 , 9 arterial stiffness progression, 10 and diabetic nephropathy. 11 However, evidence supporting the association between the TyG index and hypertension‐induced renal injury remains limited.…”