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: The triglyceride-glucose (TyG) index is an independent predictor of coronary artery disease (CAD). However, the relationships between the TyG index, pericoronary adipose tissue (PCAT), and atherosclerotic plaque characteristics remain unclear. Therefore, this study investigated these associations. Methods: We retrospectively collected data on patients with chest pain who underwent coronary computed tomography angiography using spectral detector computed tomography at our institution from June 2021 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, 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). Results: We enrolled 201 patients. The proportion of patients with maximum plaque stenosis, positive remodeling, low-density plaques, and high-risk plaques 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 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 multivariable 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). Conclusions: Patients with chest pain and a higher TyG index level were more likely to have severe stenosis and high-risk plaques. Moreover, FAI40keV and λHU had good correlations with the serum TyG index, which may noninvasively reflect PCAT inflammation under insulin resistance. These results may help explain the mechanisms related to plaque progression and instability in patients with insulin resistance.

Relationship Analysis Between Pericoronary Fat Attenuation Index and Parameters of Single Plaque

“…This is attributed to our patient selection, as we included patients with single plaques in their coronary arteries, mostly nonobstructive, and in the early stages of coronary atherosclerosis. This study suggests that changes in vascular inflammation detectable in the early stages of atherosclerosis precede changes in atherosclerotic plaques 17 .…”

“…The results showed that positive remodeling was independently and positively correlated with abnormal FAI value, which is consistent with previous studies. 17 In the early to middle stage of atherosclerosis development, positive remodeling reflects the degree of compression exerted on the vascular wall and endothelium by the lateral growth of the plaque, leading to damage to the vascular endothelial cells (VECs). This, in turn, stimulates VECs to express vascular cell adhesion molecules, promoting the adhesion of monocytes, T cells, and other cells to VECs.…”

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 hypertensioninduced renal injury remains limited.…”