Baritussio Anna, Vacirca Francesco, Ocagli Honoria, Tona Francesco, Pergola Valeria, Motta Raffaella, Marcolongo Renzo, Lorenzoni Giulia, Gregori Dario, Iliceto Sabino, Caforio Alida L P
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy.
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy.
J Clin Med. 2021 Sep 16;10(18):4200. doi: 10.3390/jcm10184200.
The pathophysiology of angina-like symptoms in myocarditis is still unclear. Perivascular fat attenuation index (pFAI) by coronary computed tomography angiography (CCTA) is a non-invasive marker of coronary inflammation (CI) in atherosclerosis. We explored the presence of CI in clinically suspected myocarditis with infarct-like presentation.
We retrospectively included 15 consecutive patients (67% male, age 30 ± 10 years) with clinically suspected infarct-like myocarditis who underwent CCTA to rule out coronary artery disease. Right coronary artery (RCA) pFAI mean value was compared with that of healthy volunteers.
Mean RCA pFAI value was -92.8 ± 8.4 HU, similar to that of healthy volunteers (-95.2 ± 6.0, = 0.8). We found no correlation between RCA pFAI mean values and peak Troponin I (r = -0.43, = 0.11) and C-reactive protein at diagnosis (r = -0.25, = 0.42). Patients with higher pFAI values showed higher biventricular end-systolic volumes (ESV) ( = 0.038 for left and = 0.024 for right ventricle) and lower right ventricular ejection fraction (RVEF) ( = 0.038) on cardiovascular magnetic resonance.
In clinically suspected myocarditis with infarct-like presentation, RCA pFAI values are lower than those validated in atherosclerosis. The correlation between higher pFAI values, higher biventricular ESV and lower RVEF, may suggest a role of pFAI in predicting non-atherosclerotic CI (i.e., infective/immune-mediated "endothelialitis").
心肌炎中类心绞痛症状的病理生理学仍不清楚。冠状动脉计算机断层扫描血管造影（CCTA）测定的血管周围脂肪衰减指数（pFAI）是动脉粥样硬化中冠状动脉炎症（CI）的一种非侵入性标志物。我们探讨了临床疑似梗死样表现的心肌炎中CI的存在情况。
我们回顾性纳入了15例连续的临床疑似梗死样心肌炎患者（男性占67%，年龄30±10岁），这些患者接受了CCTA以排除冠状动脉疾病。将右冠状动脉（RCA）的pFAI平均值与健康志愿者的进行比较。
RCA的平均pFAI值为-92.8±8.4HU，与健康志愿者的相似（-95.2±6.0，P=0.8）。我们发现RCA的pFAI平均值与肌钙蛋白I峰值（r=-0.43，P=0.11）以及诊断时的C反应蛋白（r=-0.25，P=0.42）之间无相关性。pFAI值较高的患者在心血管磁共振成像上显示出较高的双心室收缩末期容积（ESV）（左心室P=0.038，右心室P=0.024）和较低的右心室射血分数（RVEF）（P=0.038）。
在临床疑似梗死样表现的心肌炎中，RCA的pFAI值低于在动脉粥样硬化中验证的值。较高的pFAI值、较高的双心室ESV和较低的RVEF之间的相关性可能提示pFAI在预测非动脉粥样硬化性CI（即感染性/免疫介导的“内皮炎症”）中发挥作用。
