Pericoronary adipose tissue computed tomography attenuation distinguishes different stages of coronary artery disease: a cross-sectional study
Pericoronary adipose tissue computed tomography attenuation distinguishes different stages of coronary artery disease: a cross-sectional study
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冠状动脉周围脂肪组织计算机断层扫描衰减可区分冠状动脉疾病的不同阶段：一项横断面研究
DOI：
10.1093/ehjci/jeaa224
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发表时间：
2021-03-01
影响因子：
6.2
通讯作者：
Wong, Dennis T. L.
中科院分区：
文献类型：
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作者：
Lin, Andrew;Nerlekar, Nitesh;Wong, Dennis T. L.
目的血管炎症抑制冠状动脉周围脂肪组织（PCAT）的局部脂肪生成，这可以通过冠状动脉计算机断层血管造影（CCTA）检测到，因为右冠状动脉近端（RCA）周围的PCAT的CT衰减增加。在这项横断面研究中，我们评估了PCAT CT衰减作为冠状动脉炎症的成像生物标志物在区分冠状动脉疾病（CAD）不同阶段中的效用。方法和结果前瞻性招募60例急性心肌梗死（MI）患者，在入院48小时内接受CCTA，然后进行有创血管造影。这些参与者按年龄、性别、BMI、危险因素、药物和CT管电压与稳定型CAD患者（n = 60）和无CAD对照组（n = 60）相匹配。使用半自动软件量化每位患者近端RCA周围的PCAT衰减。与稳定的CAD患者（-90.6 +/- 5.7 HU, P < 0.001）和对照组（-95.8 +/- 6.2 HU, P < 0.001）相比，MI患者的PCAT衰减（-82.3 +/- 5.5 HU）更高。稳定型CAD患者的PCAT衰减明显高于对照组（P = 0.01）。PCAT衰减与CAD分期的相关性与年龄、性别、心血管危险因素、心外膜脂肪组织体积和ccta衍生的定量斑块负担无关。没有观察到临床表现（心肌梗死vs.稳定CAD）和斑块负担对PCAT衰减的相互作用。结论PCAT CT衰减可作为全局冠状动脉炎症的定量指标，独立区分心肌梗死、稳定型冠心病和非冠心病患者。未来的研究应该评估这种成像生物标志物是否可以追踪CAD不同阶段患者对治疗的反应。
Aims Vascular inflammation inhibits local adipogenesis in pericoronary adipose tissue (PCAT) and this can be detected on coronary computed tomography angiography (CCTA) as an increase in CT attenuation of PCAT surrounding the proximal right coronary artery (RCA). In this cross-sectional study, we assessed the utility of PCAT CT attenuation as an imaging biomarker of coronary inflammation in distinguishing different stages of coronary artery disease (CAD).Methods and results Sixty patients with acute myocardial infarction (MI) were prospectively recruited to undergo CCTA within 48 h of admission, prior to invasive angiography. These participants were matched to patients with stable CAD (n = 60) and controls with no CAD (n = 60) by age, gender, BMI, risk factors, medications, and CT tube voltage. PCAT attenuation around the proximal RCA was quantified per-patient using semi-automated software. Patients with MI had a higher PCAT attenuation (-82.3 +/- 5.5 HU) compared with patients with stable CAD (-90.6 +/- 5.7 HU, P < 0.001) and controls (-95.8 +/- 6.2 HU, P < 0.001). PCAT attenuation was significantly increased in stable CAD patients over controls (P = 0.01). The association of PCAT attenuation with stage of CAD was independent of age, gender, cardiovascular risk factors, epicardial adipose tissue volume, and CCTA-derived quantitative plaque burden. No interaction was observed for clinical presentation (MI vs. stable CAD) and plaque burden on PCAT attenuation.Conclusion PCAT CT attenuation as a quantitative measure of global coronary inflammation independently distinguishes patients with MI vs. stable CAD vs. no CAD. Future studies should assess whether this imaging biomarker can track patient responses to therapies in different stages of CAD.