冠状动脉周围脂肪组织衰减与慢性冠状动脉综合征患者的非钙化斑块负担相关。
Pericoronary adipose tissue attenuation is associated with non-calcified plaque burden in patients with chronic coronary syndromes.
机构信息
GRN Hospital Weinheim, Cardiology, Vascular Medicine & Pneumology, Weinheim, Germany; Cardiac Imaging Center Weinheim, Hector Foundations, Weinheim, Germany.
Department of Nuclear Medicine, Cardiac Imaging, University and University Hospital Zurich, Zurich, Switzerland.
出版信息
J Cardiovasc Comput Tomogr. 2023 Nov-Dec;17(6):384-392. doi: 10.1016/j.jcct.2023.08.008. Epub 2023 Aug 31.
BACKGROUND
Pericoronary adipose tissue attenuation (PCAT) is a marker of inflammation of the pericoronary fat tissue, which can be assessed by coronary computed tomography angiography (CCTA). Its prognostic value was reported in previous studies. Nevertheless, the relationship between PCAT, plaque burden and coronary artery disease (CAD) severity, are not well defined.
AIM
We sought to evaluate the relationship between PCAT, CAD severity based on the CAD-RADS 2.0 score and plaque burden in patients with chronic coronary syndrome (CCS).
METHODS
Consecutive patients with a clinical indication for CCTA due to suspected or known CCS were included in our study. PCAT was measured in the proximal 4 cm of each of the right coronary artery (RCA), left anterior descending artery (LAD), and the left circumflex artery (LCX). The CAD-RADS 2.0 score was assessed in all patients and total, calcified, and non-calcified plaque burden was quantitatively measured.
RESULTS
868 patients (median age of 67.0 (IQR = 58.0-75.0)yrs., 400 (46.1%) female) underwent CCTA between September 2020 and August 2022 due to CCS. Weak correlations were found between PCAT and the total plaque burden, as well as with the Agatston score, whereas no correlations were found between PCAT and CAD-RADS 2.0 score. Associations were also observed between the PCAT of the LAD, RCA and LCX with non-calcified plaque burden (Odds ratios of 1.22 (95%CI = 1.15-1.29), 1.11 (95%CI = 1.07-1.17) and 1.14 (95%CI = 1.08-1.14), respectively, p < 0.001 for all) which were independent of age, the Agatston score, and the CAD-RADS 2.0 score). In addition, higher PCAT were noticed with increasing number of plaques, exhibiting high-risk features per patient (p < 0.05 by ANOVA for all).
CONCLUSION
PCAT exhibits significant associations with non-calcified plaque burden and plaques with high-risk features in patients undergoing CCTA for CCS. Thus, PCAT may identify high-risk patients who could benefit from more aggressive preventive therapy, which merits further investigation in future studies.
背景
冠状动脉周围脂肪组织衰减（PCAT）是冠状动脉周围脂肪组织炎症的标志物，可以通过冠状动脉计算机断层扫描血管造影（CCTA）进行评估。其在先前的研究中被报道具有预后价值。然而，PCAT 与斑块负荷和冠状动脉疾病（CAD）严重程度之间的关系尚不清楚。
目的
我们旨在评估 PCAT 与慢性冠状动脉综合征（CCS）患者的 CAD 严重程度（基于 CAD-RADS 2.0 评分）和斑块负荷之间的关系。
方法
我们连续纳入因疑似或已知 CCS 而接受 CCTA 检查的患者。在每位患者的右冠状动脉（RCA）、左前降支（LAD）和左回旋支（LCX）近端 4 cm 处测量 PCAT。对所有患者进行 CAD-RADS 2.0 评分评估，并定量测量总、钙化和非钙化斑块负荷。
结果
2020 年 9 月至 2022 年 8 月，因 CCS 行 CCTA 检查的 868 例患者（中位年龄 67.0（IQR=58.0-75.0）岁，400 例[46.1%]为女性）。PCAT 与总斑块负荷和 Agatston 评分呈弱相关，而与 CAD-RADS 2.0 评分无相关性。LAD、RCA 和 LCX 的 PCAT 与非钙化斑块负荷也存在相关性（比值比分别为 1.22（95%CI=1.15-1.29）、1.11（95%CI=1.07-1.17）和 1.14（95%CI=1.08-1.14），p 值均<0.001），且独立于年龄、Agatston 评分和 CAD-RADS 2.0 评分。此外，随着斑块数量的增加，PCAT 值更高，且每位患者具有高危特征（方差分析 p 值均<0.05）。
结论
在因 CCS 而行 CCTA 的患者中，PCAT 与非钙化斑块负荷和具有高危特征的斑块显著相关。因此，PCAT 可能识别出高危患者，他们可能受益于更积极的预防治疗，这值得在未来的研究中进一步探讨。
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