Human coronary inflammation by computed tomography: Relationship with coronary microvascular dysfunction

Atrial Fibrillation and Peri-Atrial Inflammation Measured through Adipose Tissue Attenuation on Cardiac Computed Tomography

“…The current study establishes that the mean Fat-LA attenuation is a variable that is independently associated with the presence of AF, and incrementally to other known, associated variables. We hypothesize that this association is due to the fact that a higher Fat-LA attenuation may represent a measure of atrial inflammation, similarly to the established link between peri-vascular fat attenuation and inflammation in the coronary arteries [15,18,22,23]. Fat-LA volume was only apparently associated with AF, since, importantly, it was no longer significant when appropriately accounting for a higher volume of the LA in AF patients, which made their sampled ROI bigger, and their fat measured more abundant; in absolute terms, in conclusion, we found more Fat-LA in AF patients simply because we sampled a larger volume.…”

“…Several studies have indirectly suggested that inflammation is involved in atrial fibrillation, however, direct evidence of local inflammatory activity in the atria of patients with AF is scarce [8][9][10][11][12][13][14]. We hypothesized that the density of adipose tissue, also defined as "attenuation" when measured with CCTA, in close anatomic continuum with the LA, may be considered as a marker of the local inflammatory status, similarly to what has been previously demonstrated for peri-vascular adipose tissue attenuation and vascular inflammation [15][16][17][18][19][20]. The assessment of the mean density of adipose tissue in continuum with the LA will confirm (or contradict) such atrial inflammatory involvement in AF, using in-vivo imaging.…”

“…Few studies have also tried to directly and specifically "image" atrial inflammation, as we also did, in our case by taking advantage of the measurement of CCTA adipose tissue attenuation. Most of such "atrial inflammation" imaging data come from isolated case-reports, but also from a few 18 FDG-PET studies that have demonstrated a higher atrial tracer uptake in AF patients [25,26], although at least one study did not confirm this finding [27]. Furthermore, this metabolic 18 FDG approach to inflammation imaging is nowadays seriously questioned, as 18 FDG uptake is probably not truly selective for inflammation or macrophage activity; another criticism concerning the use of 18 FDG imaging in AF is that, even if it were specific for inflammation, 18 FDG activity could be weakened by the presence of atrial fibrosis, which is typical of AF, which represents a potential confounder, since it may diminish cumulative atrial cells' metabolism, and hence 18 FDG uptake [28].…”

High pericoronary adipose tissue attenuation on computed tomography angiography predicts cardiovascular events in patients with type 2 diabetes mellitus: post-hoc analysis from a prospective cohort study

“…Emerging evidence indicates that coronary microvascular dysfunction is linked to heart failure with preserved ejection fraction [ 31 , 32 ]. Meanwhile, recent studies have demonstrated the significant association between PCAT attenuation and microvascular coronary dysfunction [ 33 , 34 ]. Thus, there is a possibility that high PCAT attenuation is associated with an increased risk of heart failure.…”

Role of Epicardial Adipose Tissue in Cardiovascular Diseases: A Review

“…Kanaji et al showed that in CAD patients with a single de novo lesion, PCAT attenuation is significantly associated with global coronary flow reserve [47]. Pasqualetto et al suggested an association between PCAT attenuation in CT with coronary microvascular dysfunction; however, a significant correlation was found only in patients without severe obstructive CAD [48]. Another study found that EAT might be associated with coronary artery spasms [49].…”