Characterization of plaque phenotypes exhibiting an elevated pericoronary adipose tissue attenuation: insights from the REASSURE-NIRS registry

Satoshi Kitahara; Yu Kataoka; Hiroyuki Miura; Tatsuya Nishii; Kunihiro Nishimura; Kota Murai; Takamasa Iwai; Hideo Matama; Satoshi Honda; Masashi Fujino; Shuichi Yoneda; Kensuke Takagi; Fumiyuki Otsuka; Yasuhide Asaumi; Yusuke Fujino; Kenichi Tsujita; Rishi Puri; Stephen J Nicholls; Teruo Noguchi

doi:10.1007/s10554-023-02907-w

Characterization of plaque phenotypes exhibiting an elevated pericoronary adipose tissue attenuation: insights from the REASSURE-NIRS registry

Int J Cardiovasc Imaging. 2023 Oct;39(10):1943-1952. doi: 10.1007/s10554-023-02907-w. Epub 2023 Jun 29.

Authors

Satoshi Kitahara^{1

2

3}, Yu Kataoka⁴, Hiroyuki Miura³, Tatsuya Nishii⁵, Kunihiro Nishimura⁶, Kota Murai^{2

3}, Takamasa Iwai³, Hideo Matama^{2

3}, Satoshi Honda³, Masashi Fujino³, Shuichi Yoneda³, Kensuke Takagi³, Fumiyuki Otsuka³, Yasuhide Asaumi³, Yusuke Fujino¹, Kenichi Tsujita⁷, Rishi Puri⁸, Stephen J Nicholls⁹, Teruo Noguchi^{2

3}

Affiliations

¹ Department of Cardiology, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa, Chiba, 277-0862, Japan.
² Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Chuo-Ku, Honjo, Kumamoto, 860-8556, Japan.
³ Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
⁴ Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan. yu.kataoka@ncvc.go.jp.
⁵ Department of Radiology, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
⁶ Department of Preventive Medicine and Epidemiology, National Cerebral & Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
⁷ Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
⁸ Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
⁹ Victorian Heart Institute, Monash University, 631 Blackburn Rd, Clayton, VIC, 3168, Australia.

Abstract

Inflammation has been considered to promote atheroma instability. Coronary computed tomography angiography (CCTA) visualizes pericoronary adipose tissue (PCAT) attenuation, which reflects coronary artery inflammation. While PCAT attenuation has been reported to predict future coronary events, plaque phenotypes exhibiting high PCAT attenuation remains to be fully elucidated. The current study aims to characterize coronary atheroma with a greater vascular inflammation. We retrospectively analyzed culprit lesions in 69 CAD patients receiving PCI from the REASSURE-NIRS registry (NCT04864171). Culprit lesions were evaluated by both CCTA and near-infrared spectroscopy/intravascular ultrasound (NIRS/IVUS) imaging prior to PCI. PCAT attenuation at proximal RCA (PCAT_RCA) and NIRS/IVUS-derived plaque measures were compared in patients with PCAT_RCA attenuation ≥ and < -78.3 HU (median). Lesions with PCAT_RCA attenuation ≥ -78.3 HU exhibited a greater frequency of maxLCBI_4mm ≥ 400 (66% vs. 26%, p < 0.01), plaque burden ≥ 70% (94% vs. 74%, p = 0.02) and spotty calcification (49% vs. 6%, p < 0.01). Whereas positive remodeling (63% vs. 41%, p = 0.07) did not differ between two groups. On multivariable analysis, maxLCBI_4mm ≥ 400 (OR = 4.07; 95%CI 1.12-14.74, p = 0.03), plaque burden ≥ 70% (OR = 7.87; 95%CI 1.01-61.26, p = 0.04), and spotty calcification (OR = 14.33; 95%CI 2.37-86.73, p < 0.01) independently predicted high PCAT_RCA attenuation. Of note, while the presence of only one plaque feature did not necessarily elevate PCAT_RCA attenuation (p = 0.22), lesions harboring two or more features were significantly associated with higher PCAT_RCA attenuation. More vulnerable plaque phenotypes were observed in patients with high PCAT_RCA attenuation. Our findings suggest PCAT_RCA attenuation as the presence of profound disease substrate, which potentially benefits from anti-inflammatory agents.

Keywords: Anti-inflammatory agents; Large plaque burden; Lipid-rich plaque; Positive remodeling; Spotty calcification.