Stress-Related Neural Activity Associates With Coronary Plaque Vulnerability and Subsequent Cardiovascular Events

Neng Dai; Xianglin Tang; Xinyu Weng; Haidong Cai; Jianhui Zhuang; Guangjie Yang; Fan Zhou; Ping Wu; Bao Liu; Shaofeng Duan; Yongfu Yu; Weifeng Guo; Zhiguo Ju; Longjiang Zhang; Zhenguang Wang; Yuetao Wang; Bin Lu; Hongcheng Shi; Juying Qian; Junbo Ge

doi:10.1016/j.jcmg.2023.04.004

Stress-Related Neural Activity Associates With Coronary Plaque Vulnerability and Subsequent Cardiovascular Events

JACC Cardiovasc Imaging. 2023 Nov;16(11):1404-1415. doi: 10.1016/j.jcmg.2023.04.004. Epub 2023 May 31.

Authors

Neng Dai¹, Xianglin Tang¹, Xinyu Weng¹, Haidong Cai², Jianhui Zhuang³, Guangjie Yang⁴, Fan Zhou⁵, Ping Wu⁶, Bao Liu⁷, Shaofeng Duan⁸, Yongfu Yu⁹, Weifeng Guo¹⁰, Zhiguo Ju¹¹, Longjiang Zhang⁵, Zhenguang Wang⁴, Yuetao Wang⁷, Bin Lu¹², Hongcheng Shi¹³, Juying Qian¹, Junbo Ge¹⁴

Affiliations

¹ Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
² Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Shanghai, China.
³ Department of Cardiology, Shanghai Tenth People's Hospital, Shanghai, China.
⁴ Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Shandong, China.
⁵ Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
⁶ Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China; Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Shanxi Medical University, Taiyuan, China.
⁷ Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China; The Nuclear Medicine and Molecular Imaging Clinical Translation Institute of Soochow University, Changzhou, Jiangsu Province, China.
⁸ GE Healthcare China, Shanghai, China.
⁹ School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
¹⁰ Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China.
¹¹ College of Medical Imaging, Shanghai University of Medicine and Health Science, Shanghai, China.
¹² Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Lab and National Center for Cardiovascular Diseases, Beijing, China.
¹³ Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
¹⁴ Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China. Electronic address: jbge@zs-hospital.sh.cn.

PMID: 37269269
DOI: 10.1016/j.jcmg.2023.04.004

Abstract

Background: Stress-related neural activity (SNA) assessed by amygdalar activity can predict cardiovascular events. However, its mechanistic linkage with plaque vulnerability is not fully elucidated.

Objectives: The authors aimed to investigate the association of SNA with coronary plaque morphologic and inflammatory features as well as their ability in predicting major adverse cardiovascular events (MACE).

Methods: A total of 299 patients with coronary artery disease (CAD) and without cancer underwent ¹⁸F-fluorodexoyglucose positron emission tomography/computed tomography (PET/CT) and available coronary computed tomographic angiography (CCTA) between January 1, 2013, and December 31, 2020. SNA and bone-marrow activity (BMA) were assessed with validated methods. Coronary inflammation (fat attenuation index [FAI]) and high-risk plaque (HRP) characteristics were assessed by CCTA. Relations between these features were analyzed. Relations between SNA and MACE were assessed with Cox models, log-rank tests, and mediation (path) analyses.

Results: SNA was significant correlated with BMA (r = 0.39; P < 0.001) and FAI (r = 0.49; P < 0.001). Patients with heightened SNA are more likely to have HRP (40.7% vs 23.5%; P = 0.002) and increase risk of MACE (17.2% vs 5.1%, adjusted HR 3.22; 95% CI: 1.31-7.93; P = 0.011). Mediation analysis suggested that higher SNA associates with MACE via a serial mechanism involving BMA, FAI, and HRP.

Conclusions: SNA is significantly correlated with FAI and HRP in patients with CAD. Furthermore, such neural activity was associated with MACE, which was mediated in part by leukopoietic activity in the bone marrow, coronary inflammation, and plaque vulnerability.

Keywords: amygdalar activity; coronary computed tomography angiography; outcomes; plaque vulnerability; positron emission tomography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Computed Tomography Angiography / methods
Coronary Angiography / methods
Coronary Artery Disease* / complications
Coronary Artery Disease* / diagnostic imaging
Coronary Stenosis* / complications
Coronary Vessels / diagnostic imaging
Humans
Inflammation / complications
Plaque, Atherosclerotic*
Positron Emission Tomography Computed Tomography
Predictive Value of Tests
Prognosis