Department of Cardiovascular Medicine, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
ESC Heart Fail. 2023 Aug;10(4):2447-2457. doi: 10.1002/ehf2.14419. Epub 2023 May 31.
Heart failure with a preserved ejection fraction (HFpEF) is associated with chronic inflammation. We aimed to investigate the association between pericoronary adipose tissue attenuation (PCATA) on coronary computed tomography angiography as a novel noninvasive marker of pericoronary inflammation and the presence of HFpEF.
This retrospective study included 607 outpatients (median age, 65 years; 50% male) who underwent both echocardiography and coronary computed tomography angiography. Patients with obstructive coronary artery disease were excluded from this study. PCATA was compared between patients with and without HFpEF, which was diagnosed according to the Heart Failure Association (HFA)-PEFF score. PCATA was assessed at the proximal 40-mm segments of all three major coronary arteries on coronary computed tomography angiography. Patients with HFpEF had higher PCATA in all coronary arteries compared to the control participants: left anterior descending artery (LAD), -65.2 ± 6.9 Hounsfield units (HU) vs. -68.1 ± 6.7 HU; left circumflex artery (LCX), -62.7 ± 6.8 HU vs. -65.4 ± 6.6 HU; and right coronary artery (RCA), -63.6 ± 8.5 HU vs. -65.5 ± 7.7 HU (P < 0.01). Multivariate logistic regression analysis, including conventional risk factors, revealed that PCATA per standard deviation in the LAD (odds ratio [OR], 1.449; 95% confidence interval [CI], 1.152-1.823), LCX (OR, 1.634; 95% CI, 1.283-2.081), and RCA (OR, 1.388; 95% CI, 1.107-1.740) were independently associated with HFpEF. The association between PCATA and HFpEF was mostly consistent across various patient clinical characteristics. The left ventricular mass and left atrial volume index showed a mild correlation with LAD-PCATA (ρ = 0.13 [P < 0.01] and ρ = 0.24 [P < 0.01]) and LCX-PCATA (ρ = 0.16 [P < 0.01] and ρ = 0.23 [P < 0.01]).
High PCATA score was significantly associated with the presence of HFpEF. Our results suggest that inflammation in the pericoronary artery adipose tissue is one of the underlying mechanisms of HFpEF.
射血分数保留的心力衰竭（HFpEF）与慢性炎症有关。我们旨在研究冠状动脉计算机断层血管造影术（CCTA）上的冠状旁脂肪组织衰减（PCATA）作为冠状旁炎症的新型无创标志物与 HFpEF 存在之间的关系。
这项回顾性研究纳入了 607 名接受超声心动图和 CCTA 的门诊患者（中位年龄 65 岁；50%为男性）。患有阻塞性冠状动脉疾病的患者被排除在本研究之外。根据心力衰竭协会（HFA）-PEFF 评分，将 PCATA 与 HFpEF 患者进行比较。在 CCTA 上评估所有 3 个主要冠状动脉近端 40mm 节段的 PCATA。与对照组相比，HFpEF 患者的所有冠状动脉中的 PCATA 更高：左前降支（LAD），-65.2±6.9 亨氏单位（HU）与-68.1±6.7 HU；左旋支（LCX），-62.7±6.8 HU 与-65.4±6.6 HU；右冠状动脉（RCA），-63.6±8.5 HU 与-65.5±7.7 HU（P<0.01）。包括常规危险因素在内的多变量逻辑回归分析表明，LAD（优势比 [OR]，1.449；95%置信区间 [CI]，1.152-1.823）、LCX（OR，1.634；95% CI，1.283-2.081）和 RCA（OR，1.388；95% CI，1.107-1.740）的 PCATA 每标准差均与 HFpEF 独立相关。PCATA 与 HFpEF 之间的关联在各种患者临床特征中基本一致。左心室质量和左心房容积指数与 LAD-PCATA（ρ=0.13[P<0.01]和 ρ=0.24[P<0.01]）和 LCX-PCATA（ρ=0.16[P<0.01]和 ρ=0.23[P<0.01]）呈轻度相关。
高 PCATA 评分与 HFpEF 的存在显著相关。我们的结果表明，冠状旁动脉脂肪组织中的炎症是 HFpEF 的潜在机制之一。
