Perivascular fat attenuation for predicting adverse cardiac events in stable patients undergoing invasive coronary angiography

Devina Chatterjee; Benjamin L Shou; Matthew B Matheson; Mohammad R Ostovaneh; Carlos Rochitte; Marcus Y Chen; Marc Dewey; Jason Ortman; Christopher Cox; Joao A C Lima; Armin Arbab-Zadeh

doi:10.1016/j.jcct.2022.05.004

Perivascular fat attenuation for predicting adverse cardiac events in stable patients undergoing invasive coronary angiography

J Cardiovasc Comput Tomogr. 2022 Nov-Dec;16(6):483-490. doi: 10.1016/j.jcct.2022.05.004. Epub 2022 May 24.

Authors

Affiliations

¹ Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA.
² Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil.
⁵ Cardiology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
⁶ Charité Medical School-Humboldt, Berlin, Germany.
⁷ Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: azadeh1@jhmi.edu.

Abstract

Background: 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.

Methods: 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 major adverse cardiovascular events (MACE) during follow up was assessed using Cox regression models.

Results: 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.

Conclusions: 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.

Keywords: Coronary artery disease; Coronary computed tomography angiography; Coronary heart disease; Multidetector computed tomography; Perivascular fat attenuation.

MeSH terms

Adipose Tissue / diagnostic imaging
Computed Tomography Angiography* / methods
Coronary Angiography / methods
Coronary Artery Disease* / diagnostic imaging
Coronary Vessels / diagnostic imaging
Humans
Middle Aged
Predictive Value of Tests

Grants and funding

ZIA HL006220/ImNIH/Intramural NIH HHS/United States