High-Risk Coronary Plaque Features: A Narrative Review

Dawson, L.; Layland, Jamie

doi:10.1007/s40119-022-00271-9

Cited by 11 publications

(8 citation statements)

References 97 publications

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“…Non-calcified plaque was defined as having an attenuation < 350 HU. Vulnerable high-risk plaque was defined as hypodense non-calcified plaque and/or positive remodelling index defined as the luminal diameter maximum stenosis divided by the luminal diameter in a proximal healthy segment > 1.10 [30] .…”

Section: Methodsmentioning

confidence: 99%

Epicardial adipose tissue volume, plaque vulnerability and myocardial ischemia in non-obstructive coronary artery disease

Khan

Berge

Eskerud

et al. 2023

IJC Heart & Vasculature

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Section: Methodsmentioning

confidence: 99%

Epicardial adipose tissue volume, plaque vulnerability and myocardial ischemia in non-obstructive coronary artery disease

Khan

Berge

Eskerud

et al. 2023

IJC Heart & Vasculature

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“…59 Multiple studies have demonstrated that CCTA is able to detect plaque features associated with ACS risk. 58,61 Yuvaraj et al matched 41 patients with stable CAD presenting with HRP on CCTA to 41 patients without HRP. They found that RCA-based PCAT MA was higher in patients with HRP than in patients without (−80.7HU ± 6.50 vs −84.2HU ± 8.09 p = 0.03).…”

Section: Pcat As a Cad Biomarkermentioning

confidence: 99%

Evaluation of pericoronary adipose tissue attenuation on CT

Fari

Harst

et al. 2023

The British Journal of Radiology

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Pericoronary adipose tissue(PCAT) is the fat deposit surrounding coronary arteries. Although PCATis part of the largerepicardial adipose tissue (EAT) depot, it has different pathophysiological features and roles in the atherosclerosis process.While EAT evaluation has been studied for years, PCAT evaluationis a relatively new concept. PCAT, especially the mean attenuationderived from CT imagesmay be used to evaluate the inflammatory status of coronary arteries non-invasively.The most commonly used measure, PCATMA, is the mean attenuation of adipose tissue of 3 mm thickness around the proximal RCA with a length of 40 mm. PCATMAcan be analyzed on a per-lesion, per-vessel or per-patient basis. Apart from PCATMA, other measures for PCAT have been studied, such asthickness, and volume.Studies have shown associations between PCATMAandanatomicaland functional severity of CAD. PCATMA is associated withplaque components and high-risk plaque features,and can discriminate patients with flow obstructing stenosis and myocardial infarction.Whether PCATMAhas value on an individual patient basis remains to be determined. Furthermore, CT imagingsettings, such as kV levelsand clinical factors such as age and sex affect PCATMAmeasurements, whichcomplicate implementation in clinical practice. For PCATMAto be widely implemented, a standardized methodologyis needed. This review gives an overview of reported PCATmethodologies used in current literature and the potential use cases in clinical practice.

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“…HRP are prone to rupture and exhibit positive remodeling without significant lumen narrowing. Standard imaging methods may not accurately assess nonobstructive, but high-risk, plaques [83]. However, innovative approaches using 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) uptake and PCAT attenuation on CT have shown promise [84][85][86].…”

Section: Correlation Between Pcat Plaque Vulnerability and Acsmentioning

confidence: 99%

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

Napoli,

Pergola,

Basile

et al. 2023

JCM

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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.

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High-Risk Coronary Plaque Features: A Narrative Review

Cited by 11 publications

References 97 publications

Epicardial adipose tissue volume, plaque vulnerability and myocardial ischemia in non-obstructive coronary artery disease

Epicardial adipose tissue volume, plaque vulnerability and myocardial ischemia in non-obstructive coronary artery disease

Evaluation of pericoronary adipose tissue attenuation on CT

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

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