Determinants of Non-calcified Low-Attenuation Coronary Plaque Burden in Patients Without Known Coronary Artery Disease: A Coronary CT Angiography Study

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2022 Apr 25

PMID 35463764

Authors

Hiroki Yamaura

Kenichiro Otsuka

Hirotoshi Ishikawa

Kuniyuki Shirasawa

Daiju Fukuda

Noriaki Kasayuki

Affiliations

Soon will be listed here.

Abstract

Background: Although epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD), it is unclear whether EAT volume (EAV) can be used to diagnose high-risk coronary plaque burden associated with coronary events. This study aimed to investigate (1) the prognostic impact of low-attenuation non-calcified coronary plaque (LAP) burden on patient level analysis, and (2) the association of EAV with LAP volume in patients without known CAD undergoing coronary computed tomography angiography (CCTA).

Materials And Methods: This retrospective study consisted of 376 patients (male, 57%; mean age, 65.2 ± 13 years) without known CAD undergoing CCTA. Percent LAP volume (%LAP, <30 HU) was calculated as the LAP volume divided by the vessel volume. EAT was defined as adipose tissue with a CT attenuation value ranging from -250 to -30 HU within the pericardial sac. The primary endpoint was a composite event of death, non-fatal myocardial infarction, and unstable angina and worsening symptoms requiring unplanned coronary revascularization >3 months after CCTA. The determinants of %LAP (Q4) were analyzed using a multivariable logistic regression model.

Results: During the follow-up period (mean, 2.2 ± 0.9 years), the primary endpoint was observed in 17 patients (4.5%). The independent predictors of the primary endpoint were %LAP (Q4) (hazard ratio [HR], 3.05; 95% confidence interval [CI], 1.09-8.54; = 0.033] in the Cox proportional hazard model adjusted by CAD-RADS category. Cox proportional hazard ratio analysis demonstrated that %LAP (Q4) was a predictor of the primary endpoint, independnet of CAD severity, Suita score, EAV, or CACS. The independent determinants of %LAP (Q4) were CACS ≥218.3 ( < 0.0001) and EAV ≥125.3 ml ( < 0.0001). The addition of EAV to CACS significantly improved the area under the curve (AUC) to identify %LAP (Q4) than CACS alone (AUC, EAV + CACS . CACS alone: 0.728 . 0.637; = 0.013).

Conclusions: CCTA-based assessment of EAV, CACS, and LAP could help improve personalized cardiac risk management by administering patient-suited therapy.

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References

Romijn M, Danad I, Bakkum M, Stuijfzand W, Tulevski I, Somsen G . Incremental diagnostic value of epicardial adipose tissue for the detection of functionally relevant coronary artery disease. Atherosclerosis. 2015; 242(1):161-6. DOI: 10.1016/j.atherosclerosis.2015.07.005. View

Otsuka K, Villiger M, Karanasos A, van Zandvoort L, Doradla P, Ren J . Intravascular Polarimetry in Patients With Coronary Artery Disease. JACC Cardiovasc Imaging. 2019; 13(3):790-801. PMC: 7241775. DOI: 10.1016/j.jcmg.2019.06.015. View

Bourantas C, Jaffer F, Gijsen F, van Soest G, Madden S, Courtney B . Hybrid intravascular imaging: recent advances, technical considerations, and current applications in the study of plaque pathophysiology. Eur Heart J. 2016; 38(6):400-412. PMC: 5837589. DOI: 10.1093/eurheartj/ehw097. View

Gitsioudis G, Schmahl C, Missiou A, Voss A, Schussler A, Abdel-Aty H . Epicardial Adipose Tissue Is Associated with Plaque Burden and Composition and Provides Incremental Value for the Prediction of Cardiac Outcome. A Clinical Cardiac Computed Tomography Angiography Study. PLoS One. 2016; 11(5):e0155120. PMC: 4871366. DOI: 10.1371/journal.pone.0155120. View

Gitsioudis G, Schussler A, Nagy E, Maurovich-Horvat P, Buss S, Voss A . Combined Assessment of High-Sensitivity Troponin T and Noninvasive Coronary Plaque Composition for the Prediction of Cardiac Outcomes. Radiology. 2015; 276(1):73-81. DOI: 10.1148/radiol.15141110. View

Maron D, Hochman J, Reynolds H, Bangalore S, OBrien S, Boden W . Initial Invasive or Conservative Strategy for Stable Coronary Disease. N Engl J Med. 2020; 382(15):1395-1407. PMC: 7263833. DOI: 10.1056/NEJMoa1915922. View

Mahabadi A, Reinsch N, Lehmann N, Altenbernd J, Kalsch H, Seibel R . Association of pericoronary fat volume with atherosclerotic plaque burden in the underlying coronary artery: a segment analysis. Atherosclerosis. 2010; 211(1):195-9. DOI: 10.1016/j.atherosclerosis.2010.02.013. View

Iacobellis G . Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nat Rev Endocrinol. 2015; 11(6):363-71. DOI: 10.1038/nrendo.2015.58. View

Hasegawa T, Otsuka K, Iguchi T, Matsumoto K, Ehara S, Nakata S . Serum n-3 to n-6 polyunsaturated fatty acids ratio correlates with coronary plaque vulnerability: an optical coherence tomography study. Heart Vessels. 2013; 29(5):596-602. DOI: 10.1007/s00380-013-0404-4. View

10.

Antonopoulos A, Sanna F, Sabharwal N, Thomas S, Oikonomou E, Herdman L . Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med. 2017; 9(398). DOI: 10.1126/scitranslmed.aal2658. View

11.

Launbo N, Zobel E, von Scholten B, Faerch K, Jorgensen P, Christensen R . Targeting epicardial adipose tissue with exercise, diet, bariatric surgery or pharmaceutical interventions: A systematic review and meta-analysis. Obes Rev. 2020; 22(1):e13136. DOI: 10.1111/obr.13136. View

12.

Taruya A, Tanaka A, Nishiguchi T, Matsuo Y, Ozaki Y, Kashiwagi M . Vasa Vasorum Restructuring in Human Atherosclerotic Plaque Vulnerability: A Clinical Optical Coherence Tomography Study. J Am Coll Cardiol. 2015; 65(23):2469-77. DOI: 10.1016/j.jacc.2015.04.020. View

13.

Nerlekar N, Brown A, Muthalaly R, Talman A, Hettige T, Cameron J . Association of Epicardial Adipose Tissue and High-Risk Plaque Characteristics: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2017; 6(8). PMC: 5586465. DOI: 10.1161/JAHA.117.006379. View

14.

Ehara S, Kobayashi Y, Yoshiyama M, Shimada K, Shimada Y, Fukuda D . Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: an intravascular ultrasound study. Circulation. 2004; 110(22):3424-9. DOI: 10.1161/01.CIR.0000148131.41425.E9. View

15.

Ito H, Wakatsuki T, Yamaguchi K, Fukuda D, Kawabata Y, Matsuura T . Atherosclerotic Coronary Plaque Is Associated With Adventitial Vasa Vasorum and Local Inflammation in Adjacent Epicardial Adipose Tissue in Fresh Cadavers. Circ J. 2020; 84(5):769-775. DOI: 10.1253/circj.CJ-19-0914. View

16.

Newby D, Adamson P, Berry C, Boon N, Dweck M, Flather M . Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med. 2018; 379(10):924-933. DOI: 10.1056/NEJMoa1805971. View

17.

Detrano R, Guerci A, Carr J, Bild D, Burke G, Folsom A . Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008; 358(13):1336-45. DOI: 10.1056/NEJMoa072100. View

18.

Nakanishi K, Fukuda S, Tanaka A, Otsuka K, Jissho S, Taguchi H . Persistent epicardial adipose tissue accumulation is associated with coronary plaque vulnerability and future acute coronary syndrome in non-obese subjects with coronary artery disease. Atherosclerosis. 2014; 237(1):353-60. DOI: 10.1016/j.atherosclerosis.2014.09.015. View

19.

Arbab-Zadeh A, Fuster V . From Detecting the Vulnerable Plaque to Managing the Vulnerable Patient: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019; 74(12):1582-1593. DOI: 10.1016/j.jacc.2019.07.062. View

20.

Everett B, Brooks M, Vlachos H, Chaitman B, Frye R, Bhatt D . Troponin and Cardiac Events in Stable Ischemic Heart Disease and Diabetes. N Engl J Med. 2015; 373(7):610-20. PMC: 4627639. DOI: 10.1056/NEJMoa1415921. View