Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia.
Department of Medicine, Monash University, Clayton, Victoria, Australia.
Eur Heart J Cardiovasc Imaging. 2021 Feb 22;22(3):298-306. doi: 10.1093/ehjci/jeaa224.
Vascular inflammation inhibits local adipogenesis in pericoronary adipose tissue (PCAT) and this can be detected on coronary computed tomography angiography (CCTA) as an increase in CT attenuation of PCAT surrounding the proximal right coronary artery (RCA). In this cross-sectional study, we assessed the utility of PCAT CT attenuation as an imaging biomarker of coronary inflammation in distinguishing different stages of coronary artery disease (CAD).
Sixty patients with acute myocardial infarction (MI) were prospectively recruited to undergo CCTA within 48 h of admission, prior to invasive angiography. These participants were matched to patients with stable CAD (n = 60) and controls with no CAD (n = 60) by age, gender, BMI, risk factors, medications, and CT tube voltage. PCAT attenuation around the proximal RCA was quantified per-patient using semi-automated software. Patients with MI had a higher PCAT attenuation (-82.3 ± 5.5 HU) compared with patients with stable CAD (-90.6 ± 5.7 HU, P < 0.001) and controls (-95.8 ± 6.2 HU, P < 0.001). PCAT attenuation was significantly increased in stable CAD patients over controls (P = 0.01). The association of PCAT attenuation with stage of CAD was independent of age, gender, cardiovascular risk factors, epicardial adipose tissue volume, and CCTA-derived quantitative plaque burden. No interaction was observed for clinical presentation (MI vs. stable CAD) and plaque burden on PCAT attenuation.
PCAT CT attenuation as a quantitative measure of global coronary inflammation independently distinguishes patients with MI vs. stable CAD vs. no CAD. Future studies should assess whether this imaging biomarker can track patient responses to therapies in different stages of CAD.
血管炎症会抑制冠状动脉周围脂肪组织（PCAT）的局部脂肪生成，这可以通过冠状动脉计算机断层扫描血管造影（CCTA）检测到，表现为围绕近端右冠状动脉（RCA）的 PCAT 的 CT 衰减增加。在这项横断面研究中，我们评估了 PCAT CT 衰减作为冠状动脉炎症的影像学生物标志物，用于区分不同阶段的冠状动脉疾病（CAD）的效用。
前瞻性招募了 60 例急性心肌梗死（MI）患者，在入院后 48 小时内行 CCTA，然后进行有创血管造影。这些患者按年龄、性别、BMI、危险因素、药物治疗和 CT 管电压与稳定型 CAD 患者（n=60）和无 CAD 对照组（n=60）相匹配。使用半自动软件对每个患者的近端 RCA 周围的 PCAT 衰减进行量化。与稳定型 CAD 患者（-90.6±5.7 HU，P<0.001）和对照组（-95.8±6.2 HU，P<0.001）相比，MI 患者的 PCAT 衰减更高（-82.3±5.5 HU）。与对照组相比，稳定型 CAD 患者的 PCAT 衰减显著增加（P=0.01）。PCAT 衰减与 CAD 分期的相关性独立于年龄、性别、心血管危险因素、心外膜脂肪组织体积和 CCTA 衍生的定量斑块负担。在 PCAT 衰减与临床表型（MI 与稳定型 CAD）和斑块负担之间未观察到相互作用。
作为一种定量测量整体冠状动脉炎症的方法，PCAT CT 衰减可独立区分 MI 患者与稳定型 CAD 患者与无 CAD 患者。未来的研究应评估该影像学生物标志物是否可以跟踪不同 CAD 阶段患者对治疗的反应。
