Asada Kazunari, Saito Yuichi, Takaoka Hiroyuki, Kitahara Hideki, Kobayashi Yoshio
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 260-8677 Chiba, Japan.
Rev Cardiovasc Med. 2025 Feb 18;26(2):26327. doi: 10.31083/RCM26327. eCollection 2025 Feb.
Coronary computed tomography angiography (CTA) can be used to quantitatively and qualitatively evaluate the characteristics of perivascular adipose tissue (PVAT), including PVAT volume and perivascular fat attenuation index (FAI). Moreover, PVAT volume and perivascular FAI on CTA are reportedly high in patients with vasospastic angina (VSA); however, previous investigations have focused on the patient rather than vessel-level analyses. Therefore, this study aimed to assess the relationship between coronary vasospasm and PVAT or FAI by using coronary CTA at the vessel level.
This retrospective study included 51 patients who underwent intracoronary acetylcholine (ACh) provocation testing for the VSA diagnosis and coronary CTA within a 6-month interval. A total of 125 coronary vessels were evaluated. PVAT and FAI on CTA were quantitatively evaluated. The primary interest of the present study was to determine the relationship between PVAT volume and FAI- and ACh-induced coronary vasospasms at the vessel level.
Of the 51 patients, 24 (47.1%) had a positive ACh provocation test (VSA), with 40 of 125 (32.0%) vessels having ACh-induced vasospasm. Obstructive epicardial coronary artery disease was observed in 12 vessels (9.6%). No significant differences in PVAT volume or FAI were identified between vessels with and without ACh-induced vasospasms. Similarly, PVAT volume and FAI did not differ significantly in the individual major coronary arteries between patients with and without positive ACh provocation test results. In contrast, FAI was significantly higher in vessels with obstructive coronary artery disease than in those without.
In patients undergoing intracoronary ACh provocation tests and coronary CTA, no significant association was observed between ACh-induced coronary vasospasm and PVAT volume or FAI at the vessel level. However, FAI significantly increased in vessels with epicardial coronary disease.
冠状动脉计算机断层扫描血管造影（CTA）可用于定量和定性评估血管周围脂肪组织（PVAT）的特征，包括PVAT体积和血管周围脂肪衰减指数（FAI）。此外，据报道，血管痉挛性心绞痛（VSA）患者的CTA上PVAT体积和血管周围FAI较高；然而，先前的研究集中在患者层面而非血管层面分析。因此，本研究旨在通过血管层面的冠状动脉CTA评估冠状动脉痉挛与PVAT或FAI之间的关系。
本回顾性研究纳入了51例在6个月内接受冠状动脉内乙酰胆碱（ACh）激发试验以诊断VSA并进行冠状动脉CTA的患者。共评估了125条冠状动脉。对CTA上的PVAT和FAI进行了定量评估。本研究的主要目的是确定血管层面PVAT体积和FAI以及ACh诱导的冠状动脉痉挛之间的关系。
51例患者中，24例（47.1%）ACh激发试验阳性（VSA），125条血管中有40条（32.0%）出现ACh诱导的血管痉挛。12条血管（9.6%）观察到阻塞性心外膜冠状动脉疾病。有和没有ACh诱导血管痉挛的血管之间，PVAT体积或FAI没有显著差异。同样，ACh激发试验结果阳性和阴性的患者之间，各主要冠状动脉的PVAT体积和FAI也没有显著差异。相比之下，有阻塞性冠状动脉疾病的血管的FAI显著高于没有的血管。
在接受冠状动脉内ACh激发试验和冠状动脉CTA的患者中，在血管层面未观察到ACh诱导的冠状动脉痉挛与PVAT体积或FAI之间存在显著关联。然而，心外膜冠状动脉疾病血管的FAI显著增加。
