Prognostic Value of RCA Pericoronary Adipose Tissue CT-Attenuation Beyond High-Risk Plaques, Plaque Volume, and Ischemia

Diemen, Pepijn A. van; Bom, Michiel J.; Driessen, Roel; Schumacher, Stefan; Everaars, Henk; Winter, Ruben W. de; Ven, Peter M. van de; Freiman, Moti; Goshen, Liran; Heijtel, Dennis; Langzam, E; Min, James K.; Leipsic, Jonathon; Raijmakers, Pieter; Rossum, Albert C. van; Danad, Ibrahim; Knaapen, Paul

doi:10.1016/j.jcmg.2021.02.026

Cited by 59 publications

(35 citation statements)

References 27 publications

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“…Yu et al recently reported that RCA-PCAT attenuation, and not LAD-PCAT attenuation, was significantly higher in T2DM patients, thereby suggesting that RCA-PCAT attenuation is a more reproducible measurement of global inflammatory status compared to LAD-PCAT attenuation [ 22 ]. In addition, the recent study by van Diemen et al reported that RCA-PCAT attenuation had more superior prognostic value than LAD-PCAT attenuation [ 23 ]. Of importance, RCA-PCAT attenuation in patients with cardiovascular events was higher than that in patients without cardiovascular events, but the difference was not statistically significant in our study.…”

Section: Discussionmentioning

confidence: 99%

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

Ichikawa

Miyoshi

Osawa

et al. 2022

Cardiovasc Diabetol

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Background Pericoronary adipose tissue (PCAT) attenuation on coronary computed tomography angiography (CTA) is a non-invasive biomarker for pericoronary inflammation. We aimed to investigate the prognostic value of PCAT attenuation in patients with type 2 diabetes mellitus (T2DM). Methods We included 333 T2DM patients (mean age, 66 years; male patients, 211; mean body mass index, 25 kg/m2) who underwent clinically indicated coronary CTA and examined their CT findings, coronary artery calcium score, pericardial fat volume, stenosis (> 50% luminal narrowing), high-risk plaque features of low-attenuation plaque and/or positive remodelling and/or spotty calcification, and PCAT attenuation. We assessed PCAT attenuation in Hounsfield units (HU) of proximal 40-mm segments of the left anterior descending artery (LAD) and right coronary artery (RCA). Cardiovascular events were defined as cardiac death, hospitalisation for acute coronary syndrome, late coronary revascularisation, and hospitalisation for heart failure. Results During a median follow-up of 4.0 years, we observed 31 cardiovascular events. LAD-PCAT attenuation was significantly higher in patients with cardiovascular events than in those without (− 68.5 ± 6.5 HU vs − 70.8 ± 6.1 HU, p = 0.045), whereas RCA-PCAT attenuation was not (p = 0.089). High LAD-PCAT attenuation (> − 70.7 HU; median value) was significantly associated with cardiovascular events in a model that included adverse CTA findings, such as significant stenosis and/or high-risk plaque (hazard ratio; 2.69, 95% confidence interval; 1.17–0.20, p = 0.020). After adding LAD-PCAT attenuation to the adverse CTA findings, the C-statistic and global chi-square values increased significantly from 0.65 to 0.70 (p = 0.037) and 10.9–15.0 (p = 0.043), respectively. Conclusions In T2DM patients undergoing clinically indicated coronary CTA, high LAD-PCAT attenuation could significantly predict cardiovascular events. This suggests that assessing LAD-PCAT attenuation can help physicians identify high-risk T2DM patients.

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Section: Discussionmentioning

confidence: 99%

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

Ichikawa

Miyoshi

Osawa

et al. 2022

Cardiovasc Diabetol

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“…(5) Observe the occurrence of adverse reactions. There may be a certain burning sensation after the injection of contrast agent, which is a normal physiological phenomenon [ 15 ]. Inform the patient not to worry too much, so as to ensure that the heart rate after the injection of the drug is stable.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the Effect of Refined Nursing Intervention on Coronary CT Imaging Microscopy

Tao

2022

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The aim is to study the benefits of using advanced medical services for coronary CT angiography. From August 2019 to August 2020, 50 patients who underwent CT angiography were selected and divided into control groups and study groups, with 25 patients in each group. The monitoring team provides basic support, and the training team provides maximum support. Experimental results showed that the positive microscopic image of the study group after the intervention was better than that of the control group, and the stress score was lower than that of the control group ( P < 0.05 s and 30.73 ± 9.57 min) and are short ( 58.32 ± 13.15 seconds and 53.17 ± 11.84 minutes) between control groups, with significant differences. The significance is ( P < 0.05 . Patient care is relevant to patients with coronary CT angiography, which has been shown to improve heart rate, reduce stress, improve microscopic imaging, and provide relevant liver function tests. It is recommended to promote the show.

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“…Due to the relatively high occurrence and severity of events in patients with non-obstructive CAD [ 13 , 14 , 15 , 16 ], the incorporation of CCTA into clinical decision-making can be of great importance for improved identification of adverse events. The main finding of our study is that there is a positive correlation between CTCA-derived features and MACEs in our very selected population of patients with mild to moderate CAD.…”

Section: Discussionmentioning

confidence: 99%

“…There is also increasing evidence that pericoronary fat inflammation (pFAI) measured in the right coronary artery (RCA) is an independent predictor of cardiovascular events and mortality [ 12 , 13 , 14 , 15 , 16 , 17 ]. In addition, other evidence exists about the role of elevated pFAI in patients with myocarditis, myocardial infarction with nonobstructive coronary arteries (MINOCA) and Takotsubo syndrome [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, pericoronary adipose tissue releases proinflammatory cytokines that can alter the structure of the coronary wall, leading to CAD [ 15 ]. Previous studies indicated that pFAI correlates with plaque attenuation components in patients with non-ST-elevation acute coronary syndrome [ 16 ]. However, studies based on the relationship between pFAI, plaque composition and outcomes in stable patients with non-obstructive CAD are scarce.…”

Section: Introductionmentioning

confidence: 99%

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Added Value of CCTA-Derived Features to Predict MACEs in Stable Patients Undergoing Coronary Computed Tomography

et al. 2022

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Clinical evidence has emphasized the importance of coronary plaques’ characteristics, rather than lumen stenosis, for the outcome of cardiovascular events. Coronary computed tomographic angiography (CCTA) has a well-established role as a non-invasive tool for assessing plaques. The aim of this study was to compare clinical characteristics and CCTA-derived information of stable patients with non-severe plaques in predicting major adverse cardiac events (MACEs) during follow-up. We retrospectively selected 371 patients (64% male) who underwent CCTA in our center from March 2016 to January 2021 with Coronary Artery Disease—Reporting and Data System (CAD-RADS) 0 to 3. Of those, 198 patients (53% male) had CAD-RADS 0 to 1. Among them, 183 (49%) had normal pericoronary fat attenuation index (pFAI), while 15 (60% male) had pFAI ≥ 70.1 Hounsfield unit (HU). The remaining 173 patients (76% male) had CAD-RADS 2 to 3 and were divided into patients with at least one low attenuation plaque (LAP) and patients without LAPs (n-LAP). Compared to n-LAP, patients with LAPs had higher pFAI (p = 0.005) and had more plaques than patients with n-LAP. Presence of LAPs was significantly higher in elderly (p < 0.001), males (p < 0.001) and patients with traditional risk factors (hypertension p = 0.0001, hyperlipemia p = 0.0003, smoking p = 0.0003, diabetes p = <0.0001, familiarity p = 0.0007). Among patients with CAD-RADS 0 to 1, the ones with pFAI ≥ 70.1 HU were more often hyperlipidemic (p = 0.05) and smokers (p = 0.007). Follow-up (25,4 months, range: 17.6–39.2 months) demonstrated that LAP and pFAI ≥ 70.1 significantly and independently (p = 0.04) predisposed to outcomes (overall mortality and interventional procedures). There is an added value of CCTA-derived features in stratifying cardiovascular risk in low- to intermediate-risk patients with non-severe, non-calcified coronary plaques. This is of utmost clinical relevance as it is possible to identify a subset of patients with increased risk who need strengthening in therapeutic management and closer follow-up even in the absence of severe CAD. Further studies are needed to evaluate the effect of medical treatments on pericoronary inflammation and plaque composition.

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Prognostic Value of RCA Pericoronary Adipose Tissue CT-Attenuation Beyond High-Risk Plaques, Plaque Volume, and Ischemia

Cited by 59 publications

References 27 publications

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

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

Evaluation of the Effect of Refined Nursing Intervention on Coronary CT Imaging Microscopy

Added Value of CCTA-Derived Features to Predict MACEs in Stable Patients Undergoing Coronary Computed Tomography

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