Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
Department of General Internal Medicine 3, Kawasaki Medical School General Medicine Centre, Okayama, Japan.
Cardiovasc Diabetol. 2022 Mar 18;21(1):44. doi: 10.1186/s12933-022-01478-9.
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).
We included 333 T2DM patients (mean age, 66 years; male patients, 211; mean body mass index, 25 kg/m) 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.
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.
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.
冠状动脉计算机断层扫描血管造影（CTA）上的冠状动脉周围脂肪组织（PCAT）衰减是冠状动脉周围炎症的一种非侵入性生物标志物。我们旨在研究 2 型糖尿病（T2DM）患者 PCAT 衰减的预后价值。
我们纳入了 333 名接受临床指征冠状动脉 CTA 的 T2DM 患者（平均年龄 66 岁；男性患者 211 名；平均体重指数 25kg/m），并检查了他们的 CT 发现、冠状动脉钙评分、心包脂肪量、狭窄（管腔狭窄>50%）、低衰减斑块和/或正性重构和/或点状钙化的高危斑块特征以及 PCAT 衰减。我们以 Hounsfield 单位（HU）评估了左前降支（LAD）和右冠状动脉（RCA）近端 40mm 节段的 PCAT 衰减。心血管事件定义为心源性死亡、因急性冠状动脉综合征住院、晚期冠状动脉血运重建和因心力衰竭住院。
在中位随访 4.0 年期间，我们观察到 31 例心血管事件。与无心血管事件的患者相比，有心血管事件的患者 LAD-PCAT 衰减明显更高（-68.5±6.5HU 与-70.8±6.1HU，p=0.045），而 RCA-PCAT 衰减则没有（p=0.089）。在包括显著狭窄和/或高危斑块等不良 CTA 发现的模型中，高 LAD-PCAT 衰减（> -70.7HU；中位数）与心血管事件显著相关（危险比，2.69；95%置信区间，1.17-0.20；p=0.020）。将 LAD-PCAT 衰减添加到不良 CTA 发现后，C 统计量和全局卡方值分别显著从 0.65 增加到 0.70（p=0.037）和从 10.9 增加到 15.0（p=0.043）。
在接受临床指征冠状动脉 CTA 的 T2DM 患者中，高 LAD-PCAT 衰减可显著预测心血管事件。这表明评估 LAD-PCAT 衰减有助于医生识别高危 T2DM 患者。
