Relationship between peri-coronary inflammation and coronary vascular function in patients with suspected coronary artery disease

Mengyu Chen; Bing Liu; Xu Li; Dong Li; Lijuan Fan

doi:10.3389/fcvm.2024.1303529

Relationship between peri-coronary inflammation and coronary vascular function in patients with suspected coronary artery disease

Front Cardiovasc Med. 2024 Feb 8:11:1303529. doi: 10.3389/fcvm.2024.1303529. eCollection 2024.

Authors

Mengyu Chen^{1

2

3}, Bing Liu^{1

2

3}, Xu Li^{1

2

3}, Dong Li⁴, Lijuan Fan^{1

2

3}

Affiliations

¹ Department of Radiology, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China.
² Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China.
³ Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China.
⁴ Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China.

Abstract

Background: In this study, we aim to investigate the relationship between the attenuation of peri-coronary adipose tissue (PCAT) in patients with suspected coronary artery disease (CAD) and the assessment of coronary vascular functions using coronary flow reserve (CFR).

Methods: We included 364 patients who underwent ¹³N-NH₃ positron emission tomography/computed tomography and coronary computed tomography angiography (CCTA). We determined the relationship between fat attenuation index (FAI), PCAT volume, and other qualitative CT-derived anatomic parameters with CFR.

Results: We detected a decrease in CFR (<2.5) in 206 (57%) patients. At the patient level, those with reduced CFR showed a significantly higher prevalence of diffused atherosclerosis (41% vs. 23%; P < 0.001) and higher FAI (-75.5 HU vs. -77.1 HU; P = 0.014). In patients without obstructive CAD, FAI was significantly higher in those with reduced CFR (-75.5 HU vs. -77.7 HU, P = 0.026). On the vessel level, 1,092 vessels were analyzed, and 642 (59%) exhibited reduced CFR. The vessels with reduced CFR presented a significantly higher prevalence of obstructive CAD (37% vs. 26%; P < 0.001), diffused atherosclerosis (22% vs. 11%; P < 0.001), low-attenuation plaque (6% vs. 3%; P = 0.030), and positive remodeling (7% vs. 2%; P = 0.001). FAI was higher in vessels with reduced CFR (-80.8 HU vs. -81.8 HU; P = 0.045) than in normal CFR. In the patient-level analysis, obstructive CAD, diffused atherosclerosis, and FAI were independently linked with CFR. FAI was still associated with global CFR after adjusting for traditional risk factors (age, hypertension, diabetes, hyperlipidemia, and smoking). FAI remained independently associated with reduced CFR in patients without obstructive CAD.

Conclusions: Coronary perivascular inflammation evaluated by CCTA was independently associated with coronary vascular function. In patients without obstructive CAD, FAI was higher in the presence of reduced CFR. Altogether, FAI can help reveal microcirculatory damage in patients who do not exhibit epicardial artery stenosis.

Keywords: coronary artery disease; coronary flow reserve; fat attenuation index; peri-coronary adipose tissue; perivascular inflammation.

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article.