Nan Lihong, Li Tongli, Ding Wenyu, Wu Mengshan, Feng Jintang, Zhang Tianzhu, Yang Fan, Li Dong, Sun Chunyang, Zhang Ningnannan, Zhang Zhang
Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.
Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China.
Quant Imaging Med Surg. 2025 Aug 1;15(8):7309-7322. doi: 10.21037/qims-24-1140. Epub 2025 Jul 29.
Coronary computed tomography angiography (CCTA) can be used to investigate the relationship between white adipose tissue (WAT) and brown adipose tissue (BAT) in pericardial fat (PF) and high-risk plaques (HRP) in patients with coronary artery disease (CAD). This study aimed to explore the association between specific components of PF and HRP/culprit ischemic plaques, as well as their mediating role in overall metabolic status, providing new imaging evidence for predicting adverse events in CAD.
The clinical risk factors and imaging images of 107 CAD patients were retrospectively analyzed. Quantification of coronary artery calcium scores (CACS), PF, WAT, BAT, and pericardial fat attenuation (PFatt) were performed on non-contrast CT images. CCTA was used to evaluate myocardial ischemia and the presence of HRP. Fractional flow reserve derived from CCTA (CT-FFR) was performed in three major coronary arteries, with a threshold of ≤0.80 considered indicative of the presence of lesion-specific ischemia. HRP was defined as the presence of at least two of the four HRP features including positive remodeling (PR), low attenuation, napkin-ring sign (NRS), and spotty calcification. Mediator analysis was performed using Hayes (2018) Model-4.
A total of 107 CAD patients aged 65±8 years were included in this study. There were 49 patients (45.79%) with HRP and 57 patients (53.27%) with lesion-specific ischemia (CT-FFR ≤0.80). PF including WAT and BAT in the HRP group was significantly higher than that in the non-HRP group (PF: 241.28 204.94 cm, P=0.005, WAT: 91.78 78.40 cm, P=0.002, BAT: 56.25 46.71 cm, P=0.008). Adding WAT to meaningful clinical risk factors and CACS increases the area under the curve (AUC) for HRP prediction {AUC [95% confidence interval (95% CI)]: 0.789 (0.692-0.887) 0.655 (0.535-0.775), P<0.05}. Interestingly, adding PF to clinical risk factors and CACS decreased the AUC for the prediction of lesion-specific ischemia with no significant difference (P=0.083) [AUC (95% CI): 0.705 (0.592-0.817) 0.796 (0.696-0.897), P<0.05]. Additionally, the mediation effect of PF accounted for 95.19% of the total effect of clinical risk factors on HRP (P<0.05).
PF is associated with HRP, and clinical risk factors increase the risk of plaque rupture by promoting PF volume accumulation, especially WAT, which may be a potential predictor of HRP.
冠状动脉计算机断层扫描血管造影（CCTA）可用于研究冠心病（CAD）患者心包脂肪（PF）中的白色脂肪组织（WAT）和棕色脂肪组织（BAT）与高危斑块（HRP）之间的关系。本研究旨在探讨PF的特定成分与HRP/罪犯缺血性斑块之间的关联及其在整体代谢状态中的中介作用，为预测CAD不良事件提供新的影像学证据。
回顾性分析107例CAD患者的临床危险因素和影像图像。在非增强CT图像上对冠状动脉钙化积分（CACS）、PF、WAT、BAT和心包脂肪衰减（PFatt）进行定量分析。使用CCTA评估心肌缺血和HRP的存在情况。在三支主要冠状动脉中进行基于CCTA的血流储备分数（CT-FFR）测定，阈值≤0.80被认为提示存在病变特异性缺血。HRP定义为存在以下四种HRP特征中的至少两种，包括正向重构（PR）、低密度、餐巾环征（NRS）和斑点状钙化。采用Hayes（2018）模型4进行中介分析。
本研究共纳入107例年龄为65±8岁的CAD患者。有49例（45.79%）患者存在HRP，57例（53.27%）患者存在病变特异性缺血（CT-FFR≤0.80）。HRP组中包括WAT和BAT的PF显著高于非HRP组（PF：241.28 vs 204.94 cm，P=0.005；WAT：91.78 vs 78.40 cm，P=0.002；BAT：56.25 vs 46.71 cm，P=0.008）。将WAT添加到有意义的临床危险因素和CACS中可增加HRP预测的曲线下面积（AUC）{AUC[95%置信区间（95%CI）]：0.789（0.692-0.887）vs 0.655（0.535-0.775），P<0.05}。有趣的是，将PF添加到临床危险因素和CACS中可降低病变特异性缺血预测的AUC，但差异无统计学意义（P=0.083）[AUC（95%CI）：0.705（0.592-0.817）vs 0.796（0.696-0.897），P<0.05]。此外，PF的中介效应占临床危险因素对HRP总效应的95.19%（P<0.05）。
PF与HRP相关，临床危险因素通过促进PF体积积累增加斑块破裂风险，尤其是WAT，其可能是HRP的潜在预测指标。
