Computed Tomography-derived Characterization of Pericoronary, Epicardial, and Paracardial Adipose Tissue and Its Association With Myocardial Ischemia as Assessed by Computed Fractional Flow Reserve

Duncker, H; Achenbach, Stephan; Moshage, M; Dey, Damini; Bittner, Daniel O.; Ammon, Fabian; Marwan, Mohamed; Goeller, Markus

doi:10.1097/rti.0000000000000632

Cited by 9 publications

(10 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It reflects the balance between lipid and aqueous phases, with a well-established association between signal attenuation and adipocyte differentiation and size, primarily driven by intracellular lipid accumulation. Generally, a gradient from higher to lower attenuation has been observed from PCAT to EAT [18,[30][31][32][33] (Figures 1 and 2 and Table 1). AT attenuation AT radiomic profile AT, adipose tissue; CCTA, coronary computed tomography angiography; CMR, cardiac magnetic resonance; TTE, transthoracic echocardiography.…”

Section: Imaging Evaluation Of Eat and Pcatmentioning

confidence: 84%

See 1 more Smart Citation

Epicardial and Pericoronary Adipose Tissue, Coronary Inflammation, and Acute Coronary Syndromes

Napoli,

Pergola,

Basile

et al. 2023

JCM

View full text Add to dashboard Cite

Vascular inflammation is recognized as the primary trigger of acute coronary syndrome (ACS). However, current noninvasive methods are not capable of accurately detecting coronary inflammation. Epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT), in addition to their role as an energy reserve system, have been found to contribute to the development and progression of coronary artery calcification, inflammation, and plaque vulnerability. They also participate in the vascular response during ischemia, sympathetic stimuli, and arrhythmia. As a result, the evaluation of EAT and PCAT using imaging techniques such as computed tomography (CT), cardiac magnetic resonance (CMR), and nuclear imaging has gained significant attention. PCAT-CT attenuation, which measures the average CT attenuation in Hounsfield units (HU) of the adipose tissue, reflects adipocyte differentiation/size and leukocyte infiltration. It is emerging as a marker of tissue inflammation and has shown prognostic value in coronary artery disease (CAD), being associated with plaque development, vulnerability, and rupture. In patients with acute myocardial infarction (AMI), an inflammatory pericoronary microenvironment promoted by dysfunctional EAT/PCAT has been demonstrated, and more recently, it has been associated with plaque rupture in non-ST-segment elevation myocardial infarction (NSTEMI). Endothelial dysfunction, known for its detrimental effects on coronary vessels and its association with plaque progression, is bidirectionally linked to PCAT. PCAT modulates the secretory profile of endothelial cells in response to inflammation and also plays a crucial role in regulating vascular tone in the coronary district. Consequently, dysregulated PCAT has been hypothesized to contribute to type 2 myocardial infarction with non-obstructive coronary arteries (MINOCA) and coronary vasculitis. Recently, quantitative measures of EAT derived from coronary CT angiography (CCTA) have been included in artificial intelligence (AI) models for cardiovascular risk stratification. These models have shown incremental utility in predicting major adverse cardiovascular events (MACEs) compared to plaque characteristics alone. Therefore, the analysis of PCAT and EAT, particularly through PCAT-CT attenuation, appears to be a safe, valuable, and sufficiently specific noninvasive method for accurately identifying coronary inflammation and subsequent high-risk plaque. These findings are supported by biopsy and in vivo evidence. Although speculative, these pieces of evidence open the door for a fascinating new strategy in cardiovascular risk stratification. The incorporation of PCAT and EAT analysis, mainly through PCAT-CT attenuation, could potentially lead to improved risk stratification and guide early targeted primary prevention and intensive secondary prevention in patients at higher risk of cardiac events.

show abstract

Section: Imaging Evaluation Of Eat and Pcatmentioning

confidence: 84%

“…Availability n. Med. 2023, 12, x FOR PEER REVIEW 3 of 19 a gradient from higher to lower attenuation has been observed from PCAT to EAT [18,[30][31][32][33] (Figures 1 and 2 and Table 1). differentiation and size, primarily driven by intracellular lipid accumulation.…”

Section: Tte Ccta Cmrmentioning

confidence: 89%

Epicardial and Pericoronary Adipose Tissue, Coronary Inflammation, and Acute Coronary Syndromes

Napoli,

Pergola,

Basile

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…Shan et al showed that only LAD-PCAT volume evaluated in CT correlated with myocardial ischemia measured by fractional flow reserve (FFR) and when combined with CAD-RADS categories it gave a huge improvement in the prediction of myocardial ischemia [210]. In contrast, Duncker et al showed that only RCA-PCAT attenuation and average PCAT attenuation, both measured in CT were significantly related to myocardial ischemia assessed by FFR, which was false for every other PCAT volume and its attenuation as well as EAT and paracardial adipose tissue volume and attenuation [231]. Zhou et al demonstrated that combining radiomics features of PCAT evaluated using CT with or without plaque characteristics was significantly related to FFR.…”

Section: Pericoronary Adipose Tissue (Pcat)mentioning

confidence: 99%

The Role of Epicardial Adipose Tissue in Acute Coronary Syndromes, Post-Infarct Remodeling and Cardiac Regeneration

Krauz,

Kempiński,

Jańczak

et al. 2024

IJMS

View full text Add to dashboard Cite

Epicardial adipose tissue (EAT) is a fat deposit surrounding the heart and located under the visceral layer of the pericardium. Due to its unique features, the contribution of EAT to the pathogenesis of cardiovascular and metabolic disorders is extensively studied. Especially, EAT can be associated with the onset and development of coronary artery disease, myocardial infarction and post-infarct heart failure which all are significant problems for public health. In this article, we focus on the mechanisms of how EAT impacts acute coronary syndromes. Particular emphasis was placed on the role of inflammation and adipokines secreted by EAT. Moreover, we present how EAT affects the remodeling of the heart following myocardial infarction. We further review the role of EAT as a source of stem cells for cardiac regeneration. In addition, we describe the imaging assessment of EAT, its prognostic value, and its correlation with the clinical characteristics of patients.

show abstract

“…Duncker et al 76 investigated the association between CT-derived characterization of different cardiac fat compartments and myocardial ischemia, as assessed by FFR CT . In a cohort of 133 patients, authors found that individuals with myocardial ischemia showed significantly higher RCA PCAT attenuation than individuals without myocardial ischemia.…”

Section: Correlation Between Epicardial Adipose Tissue/pericoronary A...mentioning

confidence: 99%

Computed tomography and nuclear medicine for the assessment of coronary inflammation: clinical applications and perspectives

Guaricci

Neglia

Acampa

et al. 2023

Journal of Cardiovascular Medicine

View full text Add to dashboard Cite

There is increasing evidence that in patients with atherosclerotic cardiovascular disease (ASCVD) under optimal medical therapy, a persisting dysregulation of the lipid and glucose metabolism, associated with adipose tissue dysfunction and inflammation, predicts a substantial residual risk of disease progression and cardiovascular events. Despite the inflammatory nature of ASCVD, circulating biomarkers such as high-sensitivity C-reactive protein and interleukins may lack specificity for vascular inflammation. As known, dysfunctional epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) produce pro-inflammatory mediators and promote cellular tissue infiltration triggering further pro-inflammatory mechanisms. The consequent tissue modifications determine the attenuation of PCAT as assessed and measured by coronary computed tomography angiography (CCTA). Recently, relevant studies have demonstrated a correlation between EAT and PCAT and obstructive coronary artery disease, inflammatory plaque status and coronary flow reserve (CFR). In parallel, CFR is well recognized as a marker of coronary vasomotor function that incorporates the haemodynamic effects of epicardial, diffuse and small-vessel disease on myocardial tissue perfusion. An inverse relationship between EAT volume and coronary vascular function and the association of PCAT attenuation and impaired CFR have already been reported. Moreover, many studies demonstrated that 18F-FDG PET is able to detect PCAT inflammation in patients with coronary atherosclerosis. Importantly, the perivascular FAI (fat attenuation index) showed incremental value for the prediction of adverse clinical events beyond traditional risk factors and CCTA indices by providing a quantitative measure of coronary inflammation. As an indicator of increased cardiac mortality, it could guide early targeted primary prevention in a wide spectrum of patients. In this review, we summarize the current evidence regarding the clinical applications and perspectives of EAT and PCAT assessment performed by CCTA and the prognostic information derived by nuclear medicine.

show abstract

Computed Tomography-derived Characterization of Pericoronary, Epicardial, and Paracardial Adipose Tissue and Its Association With Myocardial Ischemia as Assessed by Computed Fractional Flow Reserve

Cited by 9 publications

References 37 publications

Epicardial and Pericoronary Adipose Tissue, Coronary Inflammation, and Acute Coronary Syndromes

Epicardial and Pericoronary Adipose Tissue, Coronary Inflammation, and Acute Coronary Syndromes

The Role of Epicardial Adipose Tissue in Acute Coronary Syndromes, Post-Infarct Remodeling and Cardiac Regeneration

Computed tomography and nuclear medicine for the assessment of coronary inflammation: clinical applications and perspectives

Contact Info

Product

Resources

About