冠状动脉周围脂肪组织衰减对慢性冠状动脉综合征患者围手术期心肌损伤的影响
Impact of Pericoronary Adipose Tissue Attenuation on Periprocedural Myocardial Injury in Patients With Chronic Coronary Syndrome.
作者信息
Yamamoto Tetsuya, Kawamori Hiroyuki, Toba Takayoshi, Sasaki Satoru, Fujii Hiroyuki, Hamana Tomoyo, Osumi Yuto, Iwane Seigo, Naniwa Shota, Sakamoto Yuki, Matsuhama Koshi, Fukuishi Yuta, Hirata Ken-Ichi, Otake Hiromasa
机构信息
Division of Cardiovascular Medicine, Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan.
出版信息
J Am Heart Assoc. 2024 Feb 6;13(3):e031209. doi: 10.1161/JAHA.123.031209. Epub 2024 Jan 19.
BACKGROUND
Perivascular inflammation contributes to the development of atherosclerosis and microcirculatory dysfunction. Pericoronary adipose tissue (PCAT) attenuation, measured by coronary computed tomography angiography, is a potential indicator of coronary inflammation. However, the relationship between PCAT attenuation, microcirculatory dysfunction, and periprocedural myocardial injury (PMI) remains unclear.
METHODS AND RESULTS
Patients with chronic coronary syndrome who underwent coronary computed tomography angiography before percutaneous coronary intervention were retrospectively identified. PCAT attenuation and adverse plaque characteristics were assessed using coronary computed tomography angiography. The extent of microcirculatory dysfunction was evaluated using the angio-based index of microcirculatory resistance before and after percutaneous coronary intervention. Overall, 125 consecutive patients were included, with 50 experiencing PMI (PMI group) and 75 without PMI (non-PMI group). Multivariable analysis showed that older age, higher angio-based index of microcirculatory resistance, presence of adverse plaque characteristics, and higher lesion-based PCAT attenuation were independently associated with PMI occurrence (odds ratio [OR], 1.07 [95% CI, 1.01-1.13]; =0.02; OR, 1.06 [95% CI, 1.00-1.12]; =0.04; OR, 6.62 [95% CI, 2.13-20.6]; =0.001; and OR, 2.89 [95% CI, 1.63-5.11]; <0.001, respectively). High PCAT attenuation was correlated with microcirculatory dysfunction before and after percutaneous coronary intervention and its exacerbation during percutaneous coronary intervention. Adding lesion-based PCAT attenuation to the presence of adverse plaque characteristics improved the discriminatory and reclassification ability in predicting PMI.
CONCLUSIONS
Adding PCAT attenuation at the culprit lesion level to coronary computed tomography angiography-derived adverse plaque characteristics may provide incremental benefit in identifying patients at risk of PMI. Our results highlight the importance of microcirculatory dysfunction in PMI development, particularly in the presence of lesions with high PCAT attenuation.
REGISTRATION
URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057722; Unique identifier: UMIN000050662.
背景
血管周围炎症促进动脉粥样硬化和微循环功能障碍的发展。通过冠状动脉计算机断层扫描血管造影测量的冠状动脉周围脂肪组织（PCAT）衰减是冠状动脉炎症的潜在指标。然而，PCAT衰减、微循环功能障碍和围手术期心肌损伤（PMI）之间的关系仍不清楚。
方法和结果
回顾性纳入经皮冠状动脉介入治疗前接受冠状动脉计算机断层扫描血管造影的慢性冠状动脉综合征患者。使用冠状动脉计算机断层扫描血管造影评估PCAT衰减和不良斑块特征。使用基于血管造影的微循环阻力指数评估经皮冠状动脉介入治疗前后的微循环功能障碍程度。总共纳入了125例连续患者，其中50例发生PMI（PMI组），75例未发生PMI（非PMI组）。多变量分析显示，年龄较大、基于血管造影的微循环阻力指数较高、存在不良斑块特征以及基于病变的PCAT衰减较高与PMI发生独立相关（比值比[OR]，1.07[95%CI，1.01-1.13]；P=0.02；OR，1.06[95%CI，1.00-1.12]；P=0.04；OR，6.62[95%CI，2.13-20.6]；P=0.001；以及OR，2.89[95%CI，1.63-5.11]；P<0.001）。高PCAT衰减与经皮冠状动脉介入治疗前后的微循环功能障碍及其在经皮冠状动脉介入治疗期间的加重相关。将基于病变的PCAT衰减添加到不良斑块特征的存在中可提高预测PMI的辨别和重新分类能力。
结论
将罪犯病变水平的PCAT衰减添加到冠状动脉计算机断层扫描血管造影衍生的不良斑块特征中，可能在识别有PMI风险的患者方面提供额外益处。我们的结果强调了微循环功能障碍在PMI发展中的重要性，特别是在存在高PCAT衰减病变的情况下。
注册
网址：https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057722；唯一标识符：UMIN000050662。
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