Perivascular fat attenuation for predicting adverse cardiac events in stable patients undergoing invasive coronary angiography.
Perivascular fat attenuation for predicting adverse cardiac events in stable patients undergoing invasive coronary angiography.
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DOI：
10.1016/j.jcct.2022.05.004
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发表时间：
2022-11
影响因子：
5.4
通讯作者：
Arbab-Zadeh, Armin
中科院分区：
文献类型：
--
作者：
Chatterjee, Devina;Shou, Benjamin L.;Matheson, Matthew B.;Ostovaneh, Mohammad R.;Rochitte, Carlos;Chen, Marcus Y.;Dewey, Marc;Ortman, Jason;Cox, Christopher;Lima, Joao A. C.;Arbab-Zadeh, Armin
关键词：
冠状动脉周围的炎症可以使用冠状动脉周围脂肪组织衰减（PCAT）进行无创评估。虽然PCAT有望进一步对低冠状动脉疾病（CAD）患病率患者进行风险分层，但其在高风险人群中的价值仍不清楚。CORE 320入组的已知或疑似CAD患者转诊接受侵入性冠状动脉造影。收集了381例患者的冠状动脉计算机断层扫描血管造影（CCTA）图像，并在入组后5年评估了这些患者的临床结局。使用半自动图像分析软件，获得右冠状动脉（RCA）、左前降支（LAD）和左回旋支（LCx）的PCAT并进行标准化。使用考克斯回归模型评估随访期间PCAT与MACE之间的关联。37例患者因技术故障被排除。其余344例患者的中位年龄为62岁（四分位距，55-68岁），59%的患者有≥1处冠状动脉狭窄，定量冠状动脉造影显示狭窄≥50%。RCA、LAD和LCx中PCAT的平均衰减值分别为−74.9、−74.2和−71.2。RCA、LAD和LCx中MACE的标准化PCAT的风险比和95%置信区间（CI）分别为0.96（CI：0.75-1.22，p=0.71）、1.31（95%CI：0.96-1.78，p=0.09）和0.98（95%CI：0.78-1.22，p=0.84）。仅死亡、卒中或心肌梗死的风险比分别为0.68（0.44-1.07）、0.85（0.56-1.29）和0.57（0.41-0.80）。在怀疑CAD的介入性冠状动脉造影患者中，PCAT在长期随访期间不能预测MACE。PCAT与CAD风险之间的关系有待进一步研究。冠状动脉周围脂肪组织衰减（PCAT）增加已被引入作为血管周围炎症的标志物，并作为接受CT血管造影术的疑似冠状动脉疾病患者的主要不良心血管事件（MACE）的预测因子。尚不清楚PCAT是否可预测高风险人群中的MACE。在我们的研究中，已知或疑似冠状动脉疾病的患者转诊进行侵入性冠状动脉造影，在三支冠状动脉中评估的原始或标准化PCAT不能预测MACE。我们的研究结果表明，人口的具体特点可能会影响性能的PCAT预测患者的结果。
Inflammation surrounding the coronary arteries can be non-invasively assessed using pericoronary adipose tissue attenuation (PCAT). While PCAT holds promise for further risk stratification of patients with low coronary artery disease (CAD) prevalence, its value in higher risk populations remains unknown. CORE320 enrolled patients referred for invasive coronary angiography with known or suspected CAD. Coronary computed tomography angiography (CCTA) images were collected for 381 patients for whom clinical outcomes were assessed 5 years after enrollment. Using semi-automated image analysis software, PCAT was obtained and normalized for the right coronary (RCA), left anterior descending (LAD), and left circumflex arteries (LCx). The association between PCAT and MACE during follow up was assessed using Cox regression models. Thirty-seven patients were excluded due to technical failure. For the remaining 344 patients, median age was 62 (interquartile range, 55–68) with 59% having ≥1 coronary artery stenosis of ≥50% by quantitative coronary angiography. Mean attenuation values for PCAT in RCA, LAD, and LCx were −74.9, −74.2, and −71.2, respectively. Hazard ratios and 95% confidence intervals (CI) for normalized PCAT in the RCA, LAD, and LCx for MACE were 0.96 (CI: 0.75–1.22, p=0.71), 1.31 (95% CI: 0.96–1.78, p=0.09), and 0.98 (95%CI: 0.78–1.22, p=0.84), respectively. For death, stroke, or myocardial infarction only, hazard ratios were 0.68 (0.44–1.07), 0.85 (0.56–1.29, and 0.57 (0.41–0.80), respectively. In patients referred for invasive coronary angiography with suspected CAD, PCAT did not predict MACE during long term follow up. Further studies are needed to understand the relationship of PCAT with CAD risk. Increased pericoronary adipose tissue attenuation (PCAT) has been introduced as a marker of perivascular inflammation and as a predictor of major adverse cardiovascular events (MACE) in patients with suspected coronary artery disease undergoing CT angiography. It remains unknown if PCAT is predictive of MACE in higher risk populations. In our study of patients with known or suspected coronary artery disease referred for invasive coronary angiography, raw or normalized PCAT assessed in the three coronary arteries did not predict MACE. Our results suggest that population specific characteristics may influence the performance of PCAT for predicting patient outcome.
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