Acute Multidisciplinary Imaging and Interventional Centre, RDM Division of Cardiovascular Medicine, University of Oxford, Headley Way, Headington, Oxford OX39DU, UK.
1st Cardiology Department, National and Kapodistrian University of Athens, Greece.
Eur Heart J. 2023 Oct 12;44(38):3827-3844. doi: 10.1093/eurheartj/ehad484.
Obesity is a modifiable cardiovascular risk factor, but adipose tissue (AT) depots in humans are anatomically, histologically, and functionally heterogeneous. For example, visceral AT is a pro-atherogenic secretory AT depot, while subcutaneous AT represents a more classical energy storage depot. Perivascular adipose tissue (PVAT) regulates vascular biology via paracrine cross-talk signals. In this position paper, the state-of-the-art knowledge of various AT depots is reviewed providing a consensus definition of PVAT around the coronary arteries, as the AT surrounding the artery up to a distance from its outer wall equal to the luminal diameter of the artery. Special focus is given to the interactions between PVAT and the vascular wall that render PVAT a potential therapeutic target in cardiovascular diseases. This Clinical Consensus Statement also discusses the role of PVAT as a clinically relevant source of diagnostic and prognostic biomarkers of vascular function, which may guide precision medicine in atherosclerosis, hypertension, heart failure, and other cardiovascular diseases. In this article, its role as a 'biosensor' of vascular inflammation is highlighted with description of recent imaging technologies that visualize PVAT in clinical practice, allowing non-invasive quantification of coronary inflammation and the related residual cardiovascular inflammatory risk, guiding deployment of therapeutic interventions. Finally, the current and future clinical applicability of artificial intelligence and machine learning technologies is reviewed that integrate PVAT information into prognostic models to provide clinically meaningful information in primary and secondary prevention.
肥胖是一种可改变的心血管危险因素，但人体脂肪组织（AT）在解剖学、组织学和功能上是异质的。例如，内脏 AT 是一种促动脉粥样硬化的分泌 AT 储存库，而皮下 AT 则代表一种更经典的能量储存储存库。血管周围脂肪组织（PVAT）通过旁分泌交叉对话信号调节血管生物学。在本立场文件中，回顾了各种 AT 储存库的最新知识，就冠状动脉周围的 PVAT 提供了共识定义，即围绕动脉的 AT 距离其外壁的距离等于动脉的管腔直径。特别关注 PVAT 与血管壁之间的相互作用，这些相互作用使 PVAT 成为心血管疾病潜在的治疗靶点。本临床共识声明还讨论了 PVAT 作为血管功能诊断和预后生物标志物的临床相关来源的作用，这可能指导动脉粥样硬化、高血压、心力衰竭和其他心血管疾病的精准医学。本文强调了其作为血管炎症的“生物传感器”的作用，并描述了最近在临床实践中可视化 PVAT 的成像技术，这些技术允许对冠状动脉炎症和相关的残余心血管炎症风险进行非侵入性定量，从而指导治疗干预的部署。最后，回顾了人工智能和机器学习技术的当前和未来临床适用性，这些技术将 PVAT 信息整合到预后模型中，为一级和二级预防提供有临床意义的信息。
