Impact of Epicardial Adipose Tissue on Coronary Plaque Composition and Major Adverse Cardiac Event Rate. A New Systematic Approach for Risk Stratification in Patients with Suspected Coronary Artery Disease: Results from the PROMISE trial

心外膜脂肪组织对冠状动脉斑块成分和主要不良心脏事件发生率的影响。

• 批准号: 290004377
• 负责人: Dr. Borek Foldyna
• 金额: --
• 依托单位: Cardiovascular Research Center (CVRC)
• 依托单位国家: 德国
• 项目类别: Research Fellowships
• 财政年份: 2016
• 资助国家: 德国
• 起止时间: 2015-12-31 至 2016-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/290004377?language=en
• 关键词: Impact; Epicardial; Adipose; Tissue; Coronary

Acute coronary syndrome, on behalf of coronary artery disease (CAD), is one of the most common causes of death in industrialized nations. Until now, in patients with suspected CAD, invasive coronary angiography and functional testing including exercise electrocardiogram, stress echocardiography and stress myocardial perfusion imaging are the gold standard methods for exclusion of CAD in symptomatic patients even with low or intermediate pretest probability. These modalities deliver only information about the lumen of coronary arteries and only limited information about the coronary wall and surrounding anatomical structures. In the last decade, computed tomography (CT) has developed into a parallel non-invasive modality, which can be used for exclusion of CAD in symptomatic patients. According to large randomized multicenter trials, CT demonstrates sensitivity and specificity comparable to the aforementioned functional testing methods. In comparison to these modalities, CT has a clear advantage to deliver additional evidence about surrounding structures such as epicardial adipose tissue (EAT). It is assumed that EAT might have exocrine and endocrine effects and may initiate inflammation-processes in the directly neighboring coronary artery wall resulting in development of CAD. It is still unclear if the volume and density of EAT influence the atherogenesis, lead to genesis of vulnerable coronary plaques and increase rate of major adverse cardiac events (MACE). Even the coronary plaque composition might depend on the volume and density of the EAT. Due to improved spatial and temporal resolution, now CT data can be used for accurate composition analysis of coronary plaques. Besides the routine visual identification of high risk coronary plaque features, CT allows a quantitative analysis of the plaque compounds such as fibrotic, fatty and calcified tissue. We assume that patients with increased volume and density of EAT might present high-risk plaque features more frequently.The primary aim of this study is to investigate the effect of EAT volume and attenuation on the coronary plaque composition and the rate of MACE in median 25 months follow-up in a large cohort. The investigation is a part of the randomized PROspective Multicenter Imaging Study for Evaluation of chest pain trial (PROMISE Trial), which enrolled more than 10,000 patients with suspected CAD. The CT data of all 4589 patients, who were randomized into the anatomical testing arm and received cardiac CT examination, will be included in our study. Besides the improvement of the CT based risk stratification in patients with suspected CAD, the EAT analysis and the coronary plaque composition analysis should build a base for future multicenter, big data studies in Germany and Europe.

急性冠状动脉综合征，代表冠状动脉疾病（CAD），是工业化国家最常见的死亡原因之一。迄今为止，对于疑似 CAD 患者，侵入性冠状动脉造影和功能测试（包括运动心电图、负荷超声心动图和负荷心肌灌注成像）是排除有症状患者 CAD 的金标准方法，即使预测概率较低或中等。这些方式仅提供有关冠状动脉管腔的信息以及有关冠状动脉壁和周围解剖结构的有限信息。在过去的十年中，计算机断层扫描 (CT) 已发展成为一种并行的非侵入性检查方式，可用于排除有症状患者的 CAD。根据大型随机多中心试验，CT 表现出与上述功能测试方法相当的敏感性和特异性。与这些方式相比，CT 具有明显的优势，可以提供有关心外膜脂肪组织 (EAT) 等周围结构的额外证据。据推测，EAT 可能具有外分泌和内分泌作用，并可能在直接相邻的冠状动脉壁中引发炎症过程，导致 CAD 的发展。目前尚不清楚 EAT 的体积和密度是否会影响动脉粥样硬化形成、导致易损冠状动脉斑块的形成并增加主要不良心脏事件 (MACE) 的发生率。甚至冠状动脉斑块的成分也可能取决于 EAT 的体积和密度。由于空间和时间分辨率的提高，现在 CT 数据可用于冠状动脉斑块的准确成分分析。除了对高风险冠状动脉斑块特征进行常规视觉识别外，CT 还可以对斑块化合物（如纤维化、脂肪和钙化组织）进行定量分析。我们假设 EAT 体积和密度增加的患者可能更频繁地出现高风险斑块特征。​​本研究的主要目的是在一个大型队列中研究 EAT 体积和衰减对冠状动脉斑块组成以及中位 25 个月随访中 MACE 发生率的影响。该研究是胸痛评估随机 PROspective 多中心影像研究试验（PROMISE 试验）的一部分，该试验招募了 10,000 多名疑似 CAD 患者。我们的研究将纳入所有 4589 名患者的 CT 数据，这些患者被随机分配到解剖测试组并接受心脏 CT 检查。除了改进疑似 CAD 患者基于 CT 的风险分层之外，EAT 分析和冠状动脉斑块成分分析还应为德国和欧洲未来的多中心大数据研究奠定基础。

项目成果

Computed tomography-based fat and muscle characteristics are associated with mortality after transcatheter aortic valve replacement.

• DOI: 10.1016/j.jcct.2018.03.007
• 发表时间: 2018-05
• 期刊: Journal of cardiovascular computed tomography
• 影响因子: 5.4
• 作者: Foldyna B;Troschel FM;Addison D;Fintelmann FJ;Elmariah S;Furman D;Eslami P;Ghoshhajra B;Lu MT;Murthy VL;Hoffmann U;Shah R
• 通讯作者: Shah R

Computed tomography improves the differentiation of infectious mediastinitis from normal postoperative changes after sternotomy in cardiac surgery

• DOI: 10.1007/s00330-018-5946-5
• 发表时间: 2019-06-01
• 期刊: EUROPEAN RADIOLOGY
• 影响因子: 5.9
• 作者: Foldyna, Borek;Mueller, Martin;Lehmkuhl, Lukas
• 通讯作者: Lehmkuhl, Lukas