Incremental prognostic value of pericoronary adipose tissue attenuation beyond conventional features in patients with nonobstructive coronary artery disease.

It remains uncertain whether pericoronary adipose tissue attenuation (PCATa) is associated with clinical outcome in patients with nonobstructive coronary artery disease (CAD). We aim to investigate the incremental prognostic value of PCATa beyond clinical and coronary computed tomographic angiography (CCTA) features in patients with nonobstructive CAD. Consecutive patients with chest pain suspected of CAD referred for CCTA from January 2017 to December 2018 were prospectively included. Multivariable Cox proportional hazard regression analysis was employed to identify the predictive factors for major adverse cardiovascular events (MACE), while the receiver operating characteristics (ROC) curve was utilized to assess the discriminatory capacity of PCATa. Kaplan-Meier curves were ultilized to visually represent event-free survival and were compared using Log-rank tests among groups stratified by high-risk plaque (HRP) and PCATa. Of the 1614 patients (mean age 59.0 years, 55.6 % male) with nonobstructive CAD, 68 (4.2 %) suffered MACE during a median follow-up of 28.6 months. After multivariable adjustment, PCATa was identified as an independent predictor (HR: 1.060, 95%CI: 1.025-1.096, p = 0.001). The inclusion of PCATa significantly enhanced the discrimination capacity [AUC:0.72 (0.66-0.78), p = 0.041] and risk reclassification (NRI = 1.99, p < 0.001; IDI = 0.93, p < 0.001) beyond the influence of clinical and CCTA factors. In the presence of HRP, a higher PCATa was found to be associated with a relatively higher risk of MACE compared to a lower PCATa (HR: 2.45, 95%CI: 1.09-5.52, p = 0.031). PCATa is positively correlated with adverse outcome in patients with nonobstructive CAD, and it offers incremental predictive value beyond clinical variables and CCTA characteristics.

Zheng N ，Liu Z ，Ding Y ，Wang X ，Li J ，Dou G ，Xin R ，Guo Z ，Chen G ，Jing J ，He B ，Shan D ，Yang J ... -  《-》

Incremental Prognostic Value of Perivascular Fat Attenuation Index in Patients with Diabetes with Coronary Artery Disease.

Ding Y ，Shan D ，Han T ，Liu Z ，Wang X ，Dou G ，Xin R ，Guo Z ，Chen G ，Jing J ，He B ，Chen Y ，Yang J ... -  《-》

Pericoronary adipose tissue attenuation predicts compositional plaque changes: a 12-month longitudinal study in individuals with type 2 diabetes without symptoms or known coronary artery disease.

Pericoronary adipose tissue attenuation (PCATa), derived from coronary computed tomography angiography (CCTA), is a novel marker of inflammation in the coronary arteries. Patients with type 2 diabetes mellitus (T2DM) are at elevated risk of coronary artery disease (CAD), potentially due to systemic inflammation. This study evaluated whether baseline PCATa predicts changes in plaque composition and burden over 12 months. This prospective longitudinal study included 200 participants with T2DM, who had neither symptoms nor a prior diagnosis of CAD (mean age 61 ± 9.4 years, 72% male). PCATa was measured at the baseline scan along the proximal 40 mm of each major coronary artery, and the values were averaged to calculate the participant-level PCATa. High PCATa levels were determined using the validated cut-off of -70.1 Hounsfield units. Compositional plaque changes were quantified as the differences between baseline and 12-month scans, and plaque burden was calculated as the normalized atheroma volume. Multivariable regression analyses assessed the associations between baseline PCATa and compositional plaque changes and evaluated risk factors, including high PCATa, in predicting non-calcified plaque burden progression. Plaque compositional volumes and burden increased over 12 months, while PCATa remained stable. After multivariable adjustments, baseline PCATa was significantly associated with changes in total plaque volume (β = 0.005, p = 0.005), non-calcified plaque volume (β = 0.006, p = 0.007), total plaque burden (β = 1.7, p = 0.007), and non-calcified plaque burden (β = 2.0, p = 0.006), but not with calcified plaque volume or burden. High baseline PCATa was observed in 44 participants (22%) and was the only independent predictor of non-calcified plaque burden progression (odds ratio 3.5, p = 0.002). Baseline PCATa is significantly associated with increases in total and non-calcified plaque volumes and burden over 12 months in participants with T2DM without symptoms or known CAD. High PCATa levels uniquely predict non-calcified plaque burden progression, suggesting that PCATa may serve as a marker for subclinical atherosclerosis progression. This warrants further investigation into PCATa for cardiovascular risk assessment, particularly in high-risk populations such as individuals with T2DM. Trial registration: NCT06644651. What is currently known about this topic? 1. Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) share inflammatory mechanisms. 2. Individuals with T2DM face a two- to four-fold increased risk of CAD compared with those without T2DM. 3. Pericoronary adipose tissue attenuation (PCATa) is a novel marker of coronary inflammation. What is the key research question? Can baseline PCATa predict compositional plaque changes over 12 months in T2DM without known CAD? What is new? 1. Baseline PCATa relates to higher total and non-calcified plaque (NCP) volumes after adjustment. 2. Baseline PCATa associates with increased total- and NCP burden after multivariable adjustment. 3. High baseline PCATa (> -70.1 HU) independently predicts NCP burden progression. How might this study influence clinical practice? PCATa may be a marker for subclinical atherosclerosis progression.

Overgaard KS ，Andersen TR ，Heinsen LJ ，Pararajasingam G ，Mohamed RA ，Madsen FS ，Biesenbach IIA ，Højlund K ，Lambrechtsen J ，Auscher S ，Egstrup K ... -  《Cardiovascular Diabetology》

Prognostic Value of RCA Pericoronary Adipose Tissue CT-Attenuation Beyond High-Risk Plaques, Plaque Volume, and Ischemia.

This study was designed to assess the prognostic value of pericoronary adipose tissue computed tomography attenuation (PCATa) beyond quantitative coronary computed tomography angiography (CCTA)-derived plaque volume and positron emission tomography (PET) determined ischemia. Inflammation plays a crucial role in atherosclerosis. PCATa has been shown to assess coronary-specific inflammation and is of prognostic value in patients with suspected coronary artery disease (CAD). A total of 539 patients who underwent CCTA and [15O]H2O PET perfusion imaging because of suspected CAD were included. Imaging assessment included coronary artery calcium score (CACS), presence of obstructive CAD (≥50% stenosis) and high-risk plaques (HRPs), total plaque volume (TPV), calcified/noncalcified plaque volume (CPV/NCPV), PCATa, and myocardial ischemia. The endpoint was a composite of death and nonfatal myocardial infarction. Prognostic thresholds were determined for quantitative CCTA variables. During a median follow-up of 5.0 (interquartile range: 4.7 to 5.0) years, 33 events occurred. CACS >59 Agatston units, obstructive CAD, HRPs, TPV >220 mm3, CPV >110 mm3, NCPV >85 mm3, and myocardial ischemia were associated with shorter time to the endpoint with unadjusted hazard ratios (HRs) of 4.17 (95% confidence interval [CI]: 1.80 to 9.64), 4.88 (95% CI: 1.88 to 12.65), 3.41 (95% CI: 1.72 to 6.75), 7.91 (95% CI: 3.05 to 20.49), 5.82 (95% CI: 2.40 to 14.10), 8.07 (95% CI: 3.33 to 19.55), and 4.25 (95% CI: 1.84 to 9.78), respectively (p < 0.05 for all). Right coronary artery (RCA) PCATa above scanner specific thresholds was associated with worse prognosis (unadjusted HR: 2.84; 95% CI: 1.44 to 5.63; p = 0.003), whereas left anterior descending artery and circumflex artery PCATa were not related to outcome. RCA PCATa above scanner specific thresholds retained is prognostic value adjusted for imaging variables and clinical characteristics associated with the endpoint (adjusted HR: 2.45; 95% CI: 1.23 to 4.93; p = 0.011). Parameters associated with atherosclerotic burden and ischemia were more strongly associated with outcome than RCA PCATa. Nonetheless, RCA PCATa was of prognostic value beyond clinical characteristics, CACS, obstructive CAD, HRPs, TPV, CPV, NCPV, and ischemia.

van Diemen PA ，Bom MJ ，Driessen RS ，Schumacher SP ，Everaars H ，de Winter RW ，van de Ven PM ，Freiman M ，Goshen L ，Heijtel D ，Langzam E ，Min JK ，Leipsic JA ，Raijmakers PG ，van Rossum AC ，Danad I ，Knaapen P ... -  《-》

The prognostic value of epicardial and pericoronary adipose tissue in heart failure with preserved ejection fraction using coronary computed tomography angiography.

To assess the prognostic significance of epicardial adipose tissue volume (EATv) and pericoronary adipose tissue attenuation (PCATa) in patients with heart failure with preserved ejection fraction (HFpEF). This retrospective study was based on HFpEF and controls who underwent coronary CT angiography (CCTA) screening to rule out coronary disease. Comparisons of EATv and PCATa were made between HFpEF patients and a control group, using statistical analyses including Kaplan-Meier and Cox regression to assess prognostic significance. A total of 224 patients were retrospectively analysed. The EATv was 56.1 ± 11.9 cm3 and PCATa in the right coronary artery (PCATa-RCA) was -74.7 HU ± 3.82 in HFpEF patients, which increased significantly compared with controls. Among them, 112 HFpEF patients (mean age: 71.9 ± 8.5 years; 40% male) were followed up for a median of 27 ± 0.6 months (range 2-47 months). EATv and PCATa-RCA were predictive of outcome with an optimal threshold of 56.29 cm3 and -71.17 HU, respectively. In Kaplan-Meier analysis, the high EATv and PCATa-RCA attenuation had significantly higher rates of composite outcomes (log-rank test, all P < .01). EATv and PCATa-RCA were independently predictive of outcome following adjustment for confounding variables (EATv: hazard ratio [HR] 1.03; 95% CI (1.01-1.06); P < .01, PCTAa-RCA: HR 1.44; 95% CI 1.27-1.62; P < .001)). Increased EATv and PCATa-RCA are associated with worse clinical outcomes in HFpEF patients. This study highlights the potential of CCTA-derived adipose tissue metrics as novel, non-invasive biomarkers for risk stratification in HFpEF.

Lin S ，Liu C ，Wang S ，Ding X ，Wu J ，Wang X ，Jianzhong S ... -  《-》