Weichsel Loris, André Florian, Renker Matthias, Weberling Lukas D, Breitbart Philipp, Overhoff Daniel, Beer Meinrad, Vattay Borbála, Buss Sebastian, Marwan Mohamed, Baumann Stefan, Giannopoulos Andreas A, Solowjowa Natalia, Kelle Sebastian, Frey Norbert, Korosoglou Grigorios
Vascular Medicine & Pneumology, Cardiology, GRN Hospital Weinheim, 69469 Weinheim, Germany.
Cardiac Imaging Center Weinheim, Hector Foundations, 69469 Weinheim, Germany.
Diagnostics (Basel). 2025 Sep 16;15(18):2340. doi: 10.3390/diagnostics15182340.
: To evaluate the impact of different lipid-lowering treatment intensities on high-risk plaque features and pericoronary adipose tissue (PCAT) attenuation in patients undergoing serial coronary computed tomography angiography (CCTA). : Individuals with suspected or known coronary artery disease (CAD) from 11 imaging centers who underwent serial CCTA examinations were retrospectively analyzed. Plaque volumes and PCAT were quantified, and the presence of high-risk plaque features was semi-quantitatively assessed using the (PFS). : In total, 216 consecutive patients (mean age 63.1 ± 9.7 years, 26.4% female) were included. The mean observation and treatment timespan between the CCTA scans was 824.5 (interquartile range (IQR) = 463.0-1323.0) days (27.5 months). The regression of high-risk features was more common with high-intensity versus low or no lipid-lowering treatment (HR = 4.6, 95%CI = 1.8-12.0, < 0.001) and was associated with the attenuated increase in non-calcified plaque volume ( < 0.001). PCAT decreased with increasing intensity of lipid-lowering treatment ( = 0.01) but no associations were observed between the changes in PCAT and PFS or plaque volumes. Lipid-lowering drug intensity was predictive of PFS regression ( < 0.001), whereas baseline PCAT was predictive for PFS progression ( = 0.03), both independent of age, cardiovascular risk factors, and baseline plaque volumes. : PCAT predicts the progression of high-risk coronary plaque features. High-intensity lipid-lowering drugs may cause the regression of high-risk plaque features through a plaque 'delipidization' process. Future trials are now warranted, studying if this process is potentially associated with improved clinical outcomes.
为评估不同降脂治疗强度对接受系列冠状动脉计算机断层扫描血管造影（CCTA）患者的高危斑块特征及冠状动脉周围脂肪组织（PCAT）衰减的影响。：对来自11个影像中心的疑似或已知冠心病（CAD）且接受系列CCTA检查的个体进行回顾性分析。对斑块体积和PCAT进行定量，并使用（PFS）对高危斑块特征的存在进行半定量评估。：总共纳入了216例连续患者（平均年龄63.1±9.7岁，26.4%为女性）。CCTA扫描之间的平均观察和治疗时间跨度为824.5（四分位间距（IQR）=463.0 - 1323.0）天（27.5个月）。与低强度或无降脂治疗相比，高强度降脂治疗使高危特征消退更为常见（HR = 4.6，95%CI = 1.8 - 12.0，<0.001），且与非钙化斑块体积的衰减增加相关（<0.001）。PCAT随降脂治疗强度增加而降低（=0.01），但未观察到PCAT变化与PFS或斑块体积之间存在关联。降脂药物强度可预测PFS消退（<0.001），而基线PCAT可预测PFS进展（=0.03），两者均独立于年龄、心血管危险因素和基线斑块体积。：PCAT可预测高危冠状动脉斑块特征的进展。高强度降脂药物可能通过斑块“去脂”过程导致高危斑块特征消退。现在有必要进行未来试验，研究该过程是否可能与改善临床结局相关。
