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Quintana RA, von Knebel Doeberitz P, Vatsa N, Liu C, Ko YA, De Cecco CN, van Assen M, Quyyumi AA. Intra- and inter-reader reproducibility in quantitative coronary plaque analysis on coronary computed tomography angiography. Curr Probl Cardiol 2024; 49:102585. [PMID: 38688396 PMCID: PMC11146670 DOI: 10.1016/j.cpcardiol.2024.102585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Coronary artery plaque burden, low attenuation non-calcified plaque (LAP), and pericoronary adipose tissue (PCAT) on coronary CT angiography (CCTA), have been linked to future cardiac events. The purpose of this study was to evaluate intra- and inter reader reproducibility in the quantification of coronary plaque burden and its characteristics using an artificial intelligence-enhanced semi-automated software. MATERIALS AND METHODS A total of 10 women and 6 men, aged 52 (IQR 49-58) underwent CCTA using a Siemens Somatom Force, Somatom Definition AS and Somatom Definition Flash scanners. Two expert readers utilized dedicated semi-automatic software (vascuCAP, Elucid Bioimaging, Wenham, MA) to assess calcified plaque, low attenuation plaque and PCAT. Readers were blinded to all clinical information and repeated their analysis at 6 weeks in random order to minimize recall bias. Data analysis was performed on the right and left coronary arteries. Intra- and inter-reader reproducibility was compared using Pearson correlation coefficient, while absolute values between analyses and readers were compared with paired non-parametric tests. This is a sub-study of the Specialized Center of Research Excellence (SCORE) clinical trial (5U54AG062334). RESULTS A total of 64 vessels from 16 patients were analyzed. Intra-reader Pearson correlation coefficients for calcified plaque volume, LAP volume and PCAT volumes were 0.96, 0.99 and 0.92 for reader 1 and 0.94, 0.94 and 0.95 for reader 2, respectively, (all p < 0.0001). Inter-reader Pearson correlation coefficients for calcified plaque volume, LAP and PCAT volumes were 0.92, 0.96 and 0.78, and 0.99, 0.99 and 0.93 on the second analyses, all had a p value <0.0001. There was no significant bias on the corresponding Bland-Altman analyses. CONCLUSION Volume measurement of coronary plaque burden and PCAT volume can be performed with high intra- and inter-reader agreement.
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Affiliation(s)
- Raymundo A Quintana
- Cardiovascular Imaging Section, Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Philipp von Knebel Doeberitz
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nishant Vatsa
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Chang Liu
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Carlo N De Cecco
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA; Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, USA
| | - Marly van Assen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA; Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, USA
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
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Liu M, Zhen Y, Shang J, Dang Y, Zhang Q, Ni W, Qiao Y, Hou Y. The predictive value of lesion-specific pericoronary fat attenuation index for major adverse cardiovascular events in patients with type 2 diabetes. Cardiovasc Diabetol 2024; 23:191. [PMID: 38835028 DOI: 10.1186/s12933-024-02272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND The purpose of this study was to explore the prognostic significance of the lesion-specific pericoronary fat attenuation index (FAI) in forecasting major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM). METHODS This study conducted a retrospective analysis of 304 patients diagnosed with T2DM who underwent coronary computed tomography angiography (CCTA) in our hospital from December 2011 to October 2021. All participants were followed for a period exceeding three years. Detailed clinical data and CCTA imaging features were carefully recorded, encompassing lesion-specific pericoronary FAI, FAI of the three prime coronary arteries, features of high-risk plaques, and the coronary artery calcium score (CACS). The MACE included in the study comprised cardiac death, acute coronary syndrome (which encompasses unstable angina pectoris and myocardial infarction), late-phase coronary revascularization procedures, and hospital admissions prompted by heart failure. RESULTS Within the three-year follow-up, 76 patients with T2DM suffered from MACE. The lesion-specific pericoronary FAI in patients who experienced MACE was notably higher compared to those without MACE (-84.87 ± 11.36 Hounsfield Units (HU) vs. -88.65 ± 11.89 HU, p = 0.016). Multivariate Cox regression analysis revealed that CACS ≥ 100 (hazard ratio [HR] = 4.071, 95% confidence interval [CI] 2.157-7.683, p < 0.001) and lesion-specific pericoronary FAI higher than - 83.5 HU (HR = 2.400, 95% CI 1.399-4.120, p = 0.001) were independently associated with heightened risk of MACE in patients with T2DM over a three-year period. Kaplan-Meier analysis showed that patients with higher lesion-specific pericoronary FAI were more likely to develop MACE (p = 0.0023). Additionally, lesions characterized by higher lesion-specific pericoronary FAI values were found to have a greater proportion of high-risk plaques (p = 0.015). Subgroup analysis indicated that lesion-specific pericoronary FAI higher than - 83.5 HU (HR = 2.017, 95% CI 1.143-3.559, p = 0.015) was independently correlated with MACE in patients with T2DM who have moderate to severe coronary calcification. Moreover, the combination of CACS ≥ 100 and lesion-specific pericoronary FAI>-83.5 HU significantly enhanced the predictive value of MACE in patients with T2DM within 3 years. CONCLUSIONS The elevated lesion-specific pericoronary FAI emerged as an independent prognostic factor for MACE in patients with T2DM, inclusive of those with moderate to severe coronary artery calcification. Incorporating lesion-specific pericoronary FAI with the CACS provided incremental predictive power for MACE in patients with T2DM.
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Affiliation(s)
- Meiju Liu
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Yanhua Zhen
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Jin Shang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Yuxue Dang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Qian Zhang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Weishi Ni
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Yujuan Qiao
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China.
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China.
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Xu R, Jing M, Zhu H, Xi H, Ren W, Zhou J. Relationship between different clinical characteristics and pericoronary adipose tissue attenuation values quantified from coronary computed tomographic angiography (CCTA) in patients without coronary heart disease (CHD). Quant Imaging Med Surg 2024; 14:4054-4066. [PMID: 38846302 PMCID: PMC11151263 DOI: 10.21037/qims-23-1814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/15/2024] [Indexed: 06/09/2024]
Abstract
Background Pericoronary adipose tissue (PCAT) is a sensor of vascular inflammation. Elevated PCAT attenuation values indicate the presence of coronary inflammation in patients. However, it is unclear which clinical characteristics are associated with increased PCAT attenuation values in patients without coronary heart disease (CHD). The study aims to investigate the relationship between increased PCAT attenuation values and clinical characteristics of patients without CHD. Methods We recruited 785 eligible patients without CHD who underwent coronary computed tomographic angiography (CCTA). Clinical data were recorded for each patient, and PCAT attenuation values for the left anterior descending branch (LADPCAT), left circumflex branch (LCXPCAT), and right coronary artery (RCAPCAT) were quantified by CCTA using fully automated software. Univariate and multivariate analyses were performed to identify the associations between different clinical characteristics and elevated LADPCAT, LCXPCAT, and RCAPCAT. Results Univariate analysis showed body mass index (BMI) to be positively associated with LADPCAT (rs=0.109), LCXPCAT (rs=0.076), and RCAPCAT (rs=0.083). Moreover, the duration of smoking, and drinking was positively associated with LADPCAT (rs=0.099, 0.165). Hyperlipidemia was positively associated with LADPCAT (rs=0.089) and RCAPCAT (rs=0.334), while statin use was negatively associated with RCAPCAT (rs=-0.145). Multivariate analysis showed that the significant determinants of LADPCAT were BMI (β=0.359, P=0.001), duration of smoking (β=2.612, P=0.002), drinking (β=4.106, P<0.001), and hyperlipidemia (β=1.664, P=0.027). LCXPCAT was associated with BMI (β=0.218, P=0.024), while RCAPCAT was associated with hyperlipidemia (β=6.110, P<0.001) and statin use (β=-3.338, P<0.001). Conclusions In patients without CHD, the PCAT attenuation values measured using CCTA were associated with various clinical characteristics. LADPCAT was associated with BMI, smoking duration, drinking, and hyperlipidemia. On the other hand, LCXPCAT was associated with BMI, while RCAPCAT was associated with hyperlipidemia and statin use.
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Affiliation(s)
- Rui Xu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Hao Zhu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Huaze Xi
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Wei Ren
- GE Healthcare, Computed Tomography Research Center, Beijing, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
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Dai A, Yao W, Lei J, Yan L, Dang L, Zhao H, Gu J, Li J, Nie Y, Zheng M, Wang D, Wang Q. Relationship Between Pericarotid Fat Density and Pathology-Based Carotid Plaque Risk Characteristics. J Craniofac Surg 2024:00001665-990000000-01599. [PMID: 38758573 DOI: 10.1097/scs.0000000000010276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/01/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES In this study, the authors aimed to evaluate the relationship between pericarotid fat density (PFD) and pathologic carotid plaque risk characteristics. METHODS The authors retrospectively evaluated 58 patients (mean age: 66.66 ± 7.26 y, 44 males) who were subjected to both carotid endarterectomy and carotid artery computed tomography angiography (CTA) at the authors' institution. The computed tomography values of the adipose tissue around the most severe stenosis carotid artery were measured, and the removed plaques were sent to the Department of Pathology for American Heart Association (AHA) classification. The Wilcoxon signed-rank test was used to detect the difference in PFD values between the operative and nonoperative sides. According to carotid plaque risk characteristics, the associations between PFD and 4 different risk characteristic subgroups were analyzed. The Student t test and χ2 test were used to compare differences between different risk subgroups. Receiver operating characteristic curve analysis was used to evaluate the predictive efficacy of PFD for carotid plaque risk characteristics. RESULTS The operative side had higher mean Hounsfield units (HU) values compared with the nonoperative side (P < 0.001). The AHA VI and the intraplaque hemorrhage (IPH) subgroups had higher mean HU values compared with the non-AHA VI and the non-IPH subgroups (P < 0.05). Male patients presented with IPH more than female patients (P = 0.047). The results of receiver operating characteristic curve analysis showed that the mean HU value (operative side; area under the curve: 0.729, Sensitivity (SE): 59.26%, Specificity (SP): 80.65%, P = 0.003) had a certain predictive value for diagnosing high-risk VI plaques. Pericarotid fat density ≥ -68.167 HU is expected to serve as a potential cutoff value to identify AHA VI and non-AHA VI subgroups. CONCLUSION PFD was significantly associated with vulnerable plaques, high-risk AHA VI plaques, and IPH, which could be an indirect clinical marker for vulnerable plaques.
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Affiliation(s)
- An Dai
- Department of Ultrasound, Tangshan Gongren Hospital, Tangshan
| | - Weinan Yao
- Department of Radiotherapy, North China University of Science and Technology Affiliated Hospital Tangshan
| | - Jing Lei
- Department of Radiology, Tangshan Gongren Hospital, Tangshan
| | - Limin Yan
- Department of Pathology, Tangshan Gongren Hospital, Tangshan
| | - Lei Dang
- Department of Ultrasound, Tangshan Gongren Hospital, Tangshan
| | - Haijun Zhao
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan, Hebei, PR China
| | - Jingshun Gu
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan, Hebei, PR China
| | - Jun Li
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan, Hebei, PR China
| | - Ying Nie
- Department of Ultrasound, Tangshan Gongren Hospital, Tangshan
| | - Mengru Zheng
- Department of Ultrasound, Tangshan Gongren Hospital, Tangshan
| | - Dongchun Wang
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan, Hebei, PR China
| | - Qingwen Wang
- Department of Ultrasound, Tangshan Gongren Hospital, Tangshan
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Gencer ES, Yilmaz E, Arsava EM, Gocmen R, Topcuoglu MA. Carotid Artery Perivascular Adipose Tissue Density and Response to Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke. Angiology 2024; 75:472-479. [PMID: 37163448 DOI: 10.1177/00033197231174654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The importance of Carotid Artery Perivascular Adipose Tissue Density (CAPATd), a parameter that can be readily evaluated on emergency computed tomographic angiography (CTA), in acute stroke has not been adequately clarified. We created exploratory logistic regression models to detect the interaction between the effect of CAPATd and intravenous (IV) tissue plasminogen activator (tPA) in 174 patients (mean age 71 ± 14 years, 94 women) with acute ischemic stroke treated with IV-tPA alone. The CAPATd-average mean (-60.6 ± 18.7 vs -89.8 ± 25.3 Hounsfield units (HU), P = .002) and CAPATd-maximum (14.8 ± 68.9 vs -20.5 ± 39.8 HU, P = .020) values were higher on the ipsilateral side of carotid artery stenosis >60%. CAPATd-maximum ipsilateral emerged as an independent predictor for both modified Rankin's Score 0-2 (52%) [exp(β) = .984] and mRS 0-1 outcome (32%) [exp(β) = .828] in addition to admission National Institutes of Health Stroke Scale, age and carotid plaque burden. CAPATd-maximum ipsilateral was acceptably accurate (Area under the Receiver operating characteristic Curve was .607, P = .0109 for mRS 0-2 and .613, P = .0102 for mRS 0-1). Ipsilateral CAPATd ≥ -25 HU predicted both mRS >3 and mRS >2 with usable sensitivity (59.8% and 66.07%) and specificity (63.6% and 59.68%). In conclusion, higher maximum CAPATd measured on emergency CTA indicates poorer functional prognosis in acute stroke patients treated with IV-tPA.
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Affiliation(s)
- Elif Sarionder Gencer
- Hacettepe University, Faculty of Medicine Hospital, Department of Neurology, Ankara, Turkey
- Department of Neurology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ezgi Yilmaz
- Hacettepe University, Faculty of Medicine Hospital, Department of Neurology, Ankara, Turkey
| | - Ethem Murat Arsava
- Hacettepe University, Faculty of Medicine Hospital, Department of Neurology, Ankara, Turkey
| | - Rahsan Gocmen
- Hacettepe University, Faculty of Medicine Hospital, Department of Radiology, Ankara, Turkey
| | - Mehmet Akif Topcuoglu
- Hacettepe University, Faculty of Medicine Hospital, Department of Neurology, Ankara, Turkey
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Huang R, Li W, Xie Z, Zhuo K, Zhu J. Epicardial Adipose Tissue and Major Adverse Cardiovascular Events in Myocardial Infarction Patients with and without Diabetes. Acad Radiol 2024:S1076-6332(24)00208-3. [PMID: 38653598 DOI: 10.1016/j.acra.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/19/2024] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Epicardial adipose tissue (EAT) accumulation plays a key role in the progression myocardial infarction (MI) and diabetes. Diabetic patients have elevated risk of major adverse cardiac events (MACEs) compared to non-diabetic patients. We aimed to investigate the prognostic value of EAT volume in MI patients with and without diabetes. METHODS This study included 458 MI patients who underwent cardiac computed tomography (CT) imaging and received successful stent implantation. EAT volume was quantified with cardiac CT imaging. Sub-study stratification of patients by diabetes status was further analyzed. Cox proportional hazards regression models were applied to evaluate the association between EAT volume and MACEs. RESULTS Diabetes was identified in 135 of the 458 patients (29.5%). EAT volume was significantly higher in diabetes than non-diabetes. During a median follow-up of 1154 days, MACEs occurred more frequently in patients with versus without diabetes. EAT volume was independent predictor of MACEs in all MI patients after adjustment for risk factors, and showed good predictive value in the evaluation of MACEs. Moreover, EAT volume was also significantly associated with MACEs after adjustment for risk factors in diabetes and non-diabetes in the subgroup analysis. CONCLUSION MI patients with diabetes had higher EAT volume and experienced higher rate of MACEs compared to non-diabetes. EAT volume is an independent risk of prognosis of MI, regardless of the diabetes status.
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Affiliation(s)
- Ruijue Huang
- Department of Basic Medicine, Hainan Vocational University of Science and Technology, Haikou 570100, China
| | - Wenjia Li
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China
| | - Zhen Xie
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China
| | - Kaimin Zhuo
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China
| | - Jing Zhu
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610041, China.
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Ferreira J, Longatto-Filho A, Afonso J, Roque S, Carneiro AL, Vila I, Silva C, Cunha C, Mesquita A, Cotter J, Correia-Neves M, Mansilha A, Cunha P. Inflammatory Cells in Adipose Tissue and Skeletal Muscle of Patients with Peripheral Arterial Disease or Chronic Venous Disease: A Prospective, Observational, and Histological Study. J Cardiovasc Dev Dis 2024; 11:121. [PMID: 38667739 PMCID: PMC11050534 DOI: 10.3390/jcdd11040121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
The main goal of this study was to assess whether the presence of peripheral arterial disease (PAD) correlates with increased inflammatory cell infiltration. An observational, single-centre, and prospective study was conducted from January 2018 to July 2022. Clinical characteristics and anthropometric measures were registered. Consecutive PAD patients with surgical indications for a common femoral artery approach and patients with varicose veins with an indication for surgical ligation of the saphenofemoral junction were included. In both groups, samples of sartorius skeletal muscle, subcutaneous adipose tissue (SAT), and perivascular adipose tissue (PVAT) were collected from the femoral region. We analysed the characteristics of adipocytes and the presence of haemorrhage and inflammatory cells in the samples of PVAT and SAT via haematoxylin-eosin staining. We found that patients with PAD had significantly more inflammatory cells in PVAT [16 (43.24%) vs. 0 (0%) p = 0.008]. Analysing SAT histology, we observed that patients with PAD had significantly more CD45+ leucocytes upon immunohistochemical staining [32 (72.73%) vs. 3 (27.27%) p = 0.005]. Upon analysing skeletal muscle histology with haematoxylin-eosin staining, we evaluated skeletal fibre preservation, as well as the presence of trauma, haemorrhage, and inflammatory cells. We registered a significantly higher number of inflammatory cells in patients with PAD [well-preserved skeletal fibres: PAD = 26 (63.41%) vs. varicose veins = 3 (37.50%) p = 0.173; trauma: PAD = 4 (9.76%) vs. varicose veins = 2 (25.00%) p = 0.229; haemorrhage: PAD = 6 (14.63%) vs. varicose veins = 0 (0%) p = 0.248; inflammatory cells: PAD = 18 (43.90%) vs. varicose veins = 0 (0%) p = 0.018]. Patients with PAD had a higher number of inflammatory cells in skeletal muscle and adipose tissue (PVAT and SAT) when compared with those with varicose veins, emphasizing the role of inflammation in this group of patients.
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Affiliation(s)
- Joana Ferreira
- Vascular Surgery Department–Fisiologia e Cirurgia, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- Centro Académico Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal (C.S.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
- Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo 01246-903, SP, Brazil
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-400, SP, Brazil
| | - Julieta Afonso
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
| | - Susana Roque
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
| | | | - Isabel Vila
- Centro Académico Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal (C.S.)
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Cristina Silva
- Centro Académico Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal (C.S.)
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Cristina Cunha
- Centro Académico Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal (C.S.)
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Amílcar Mesquita
- Vascular Surgery Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Jorge Cotter
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- Centro Académico Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal (C.S.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
| | - Margarida Correia-Neves
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
| | - Armando Mansilha
- Vascular Surgery Department–Fisiologia e Cirurgia, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - Pedro Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal (J.A.)
- Centro Académico Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal (C.S.)
- ICVS/3B’s–PT Government Associated Laboratory, 4710-057 Braga, Portugal
- Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department, Hospital da Senhora da Oliveira, 4835-044 Guimarães, Portugal
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Jing M, Xi H, Sun J, Zhu H, Deng L, Han T, Zhang B, Zhang Y, Zhou J. Differentiation of acute coronary syndrome with radiomics of pericoronary adipose tissue. Br J Radiol 2024; 97:850-858. [PMID: 38366613 PMCID: PMC11027295 DOI: 10.1093/bjr/tqae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/11/2023] [Accepted: 02/03/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE To assess the potential values of radiomics signatures of pericoronary adipose tissue (PCAT) in identifying patients with acute coronary syndrome (ACS). METHODS In total, 149, 227, and 244 patients were clinically diagnosed with ACS, chronic coronary syndrome (CCS), and without coronary artery disease (CAD), respectively, and were retrospectively analysed and randomly divided into training and testing cohorts at a 2:1 ratio. From the PCATs of the proximal left anterior descending branch, left circumflex branch, and right coronary artery (RCA), the pericoronary fat attenuation index (FAI) value and radiomics signatures were calculated, among which features closely related to ACS were screened out. The ACS differentiation models AC1, AC2, AC3, AN1, AN2, and AN3 were constructed based on the FAI value of RCA and the final screened out first-order and texture features, respectively. RESULTS The FAI values were all higher in patients with ACS than in those with CCS and no CAD (all P < .05). For the identification of ACS and CCS, the area-under-the-curve (AUC) values of AC1, AC2, and AC3 were 0.92, 0.94, and 0.91 and 0.91, 0.86, and 0.88 in the training and testing cohorts, respectively. For the identification of ACS and no CAD, the AUC values of AN1, AN2, and AN3 were 0.95, 0.94, and 0.94 and 0.93, 0.87, and 0.89 in the training and testing cohorts, respectively. CONCLUSIONS Identification models constructed based on the radiomics signatures of PCAT are expected to be an effective tool for identifying patients with ACS. ADVANCES IN KNOWLEDGE The radiomics signatures of PCAT and FAI values are expected to differentiate between patients with ACS, CCS and those without CAD on imaging.
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Affiliation(s)
- Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, 730030, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Huaze Xi
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, 730030, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Jianqing Sun
- Shanghai United Imaging Research Institute of Intelligent Imaging, Shanghai, 201807, China
| | - Hao Zhu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, 730030, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Liangna Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, 730030, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Tao Han
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, 730030, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Bin Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, 730030, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Yuting Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, 730030, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, 730030, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
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9
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Jia Y, Zou L, Xue M, Zhang X, Xiao X. Evaluation of peri-plaque pericoronary adipose tissue attenuation in coronary atherosclerosis using a dual-layer spectral detector CT. Front Med (Lausanne) 2024; 11:1357981. [PMID: 38533317 PMCID: PMC10964482 DOI: 10.3389/fmed.2024.1357981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Purpose This study aimed to evaluate the differences between pericoronary adipose tissue (PCAT) attenuation at different measured locations in evaluating coronary atherosclerosis using spectral computed tomography (CT) and to explore valuable imaging indicators. Methods A total of 330 patients with suspicious coronary atherosclerosis were enrolled and underwent coronary CT angiography with dual-layer spectral detector CT (SDCT). Proximal and peri-plaque fat attenuation index (FAI) of stenosis coronary arteries were measured using both conventional images (CIs) and virtual monoenergetic images (VMIs) ranging from 40 keV to 100 keV. The slopes of the spectral attenuation curve (λ) of proximal and peri-plaque PCAT at three different monoenergetic intervals were calculated. Additionally, peri-plaque FAI on CI and virtual non-contrast images, and effective atomic number were measured manually. Results A total of 231 coronary arteries with plaques and lumen stenosis were finally enrolled. Peri-plaque FAICI and FAIVMI were significantly higher in severe stenosis than in mild and moderate stenosis (p < 0.05), while peri-plaque λ, proximal FAI, and proximal λ were not statistically different. Proximal FAI, peri-plaque FAI, and peri-plaque λ were significantly higher in low-density non-calcified plaque (LD-NCP) and non-calcified plaque (NCP) than in calcified plaque (p < 0.01). Peri-plaque FAI was the highest in the LD-NCP group, while proximal FAI was the highest in the NCP group. In severe stenosis and in LD-NCP, peri-plaque FAI was significantly higher than proximal FAI (p < 0.05). The manually measured parameters related to peri-plaque PCAT attenuation had a positive correlation with the results of peri-plaque FAI measured automatically. Conclusion Peri-plaque PCAT has more value in assessing coronary atherosclerosis than proximal PCAT. Peri-plaque PCAT attenuation is expected to be used as a standard biomarker for evaluating plaque vulnerability and hemodynamic characteristics.
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Affiliation(s)
- Yulin Jia
- Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lei Zou
- Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Department of Radiology, Zigong Fourth People's Hospital, Zigong, China
| | - Ming Xue
- Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaoyu Zhang
- Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xigang Xiao
- Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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10
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Liu Y, Zhao Y, Guo Z, Zhang Y, Miao C, Gu Y. A novel predictive model based on pericarotid adipose tissue and lumen stenosis for stroke risk in patients with asymptomatic carotid stenosis. J Investig Med 2024; 72:270-278. [PMID: 38183206 DOI: 10.1177/10815589241226728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
The study aimed to investigate the predictive value of clinical characteristics, major computed tomography angiography (CTA) indexes of carotid AS (carotid lumen stenosis and plaque burden), and inflammatory pericarotid adipose tissue for acute stroke risk in patients with a moderate or higher degree of carotid stenosis. In all, 119 patients with unilateral carotid stenosis who underwent head and neck computed tomography angiography were included and assigned to the stroke group or non-stroke group according to magnetic resonance imaging. Pericarotid adipose tissue attenuation value, net enhancement value in the base phase and the enhancement phase, and atherosclerotic features (plaque burden and lumen stenosis) were recorded. Multivariate logistic regression analysis and the operating characteristic curve (ROC) were performed to establish a predictive model for the presence of acute ischemic stroke. ROC analysis showed that pericarotid adipose tissue attenuation value and lumen stenosis were predictive factors for stroke. The AUC of pericarotid adipose tissue attenuation (PCAT) attenuation, lumen stenosis, the novel prediction model independently constructed based on PCAT attenuation, and lumen stenosis resulted in 0.838 (95% CI 0.759-0.899), 0.700 (95% CI 0.826-0.944), and 0.942 (95% CI 0.884-0.977), respectively. The model had a sensitivity and specificity of 0.909 and 0.893, respectively, when the cutoff value was 0.388. We found that the risk model combining pericarotid adipose tissue attenuation value and lumen stenosis has significant predictive values for the presence of symptomatic stroke among patients with a moderate or higher degree of carotid stenosis.
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Affiliation(s)
- Ying Liu
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, P. R. China
| | - Yinan Zhao
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, P. R. China
| | - Zhongping Guo
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, P. R. China
| | - Yonggang Zhang
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, P. R. China
| | - Chongchang Miao
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, P. R. China
| | - Yan Gu
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, P. R. China
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11
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Xi H, Jing M, Sun Q, Wang Y, Zhu H, Zhou J. The relationship between different exercise conditions and pericoronary inflammation as quantified by coronary CTA in coronary artery disease. Heliyon 2024; 10:e25316. [PMID: 38352755 PMCID: PMC10861983 DOI: 10.1016/j.heliyon.2024.e25316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/21/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
Objectives The correlation between exercise type and intensity and coronary artery inflammation in patients with stable coronary artery disease (CAD) is unknown. Therefore, this study assessed the relationship between coronary inflammation quantified by coronary computed tomography angiography (CCTA) and exercise intensity and pattern in patients with CAD. Materials and methods Patients who underwent CCTA between 2019 and 2023 in the second hospital of Lanzhou University were retrospectively examined. We calculated the pericoronary fat attenuation index (FAI) on the right coronary artery (RCA) as a marker of coronary inflammation. We compared basic information, exercise status, and RCA-FAI values between the two groups, and described the relationship between different exercise durations and RCA-FAI using analysis of variance and restricted cubic splines. Results In total, 1222 patients were included: 774 had no CAD and 448 patients had CAD. Sex (P = 0.016; odds ratio [OR]: 0.673), high-density lipoprotein (P = 0.006; OR: 0.601), low-density lipoprotein (P = 0.001; OR. 0.762), hypertension (P = 0.000; OR: 0.762), smoking (P = 0.005; OR: 0.670), and postprandial glucose (P = 0.030; OR: 0.812), household income (P = 0.038; OR:1.117), and body mass index (P = 0.000; OR:1.084) were the risk factors for elevated RCA-FAI values in the patients with coronary artery disease group. And when the exercise modality was running and aerobics, the correlation between RCA-FAI values and exercise time showed a "U"-shaped relationship. Follow-up revealed that short periods of high-intensity exercise resulted in lower RCA-FAI values. Conclusion RCA-FAI was significantly associated with coronary artery inflammation. Although appropriate physical activity reduced the risk of pericoronary inflammation and coronary atherosclerosis, overly prolonged exercise could exacerbate the coronary inflammatory response and increase the likelihood of CAD.
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Affiliation(s)
- Huaze Xi
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Qiu Sun
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Yuanyuan Wang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Hao Zhu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
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12
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Zisman E, Hossain M, Funderburg NT, Christenson R, Jeudy J, Burrowes S, Hays AG, George N, Freeman ML, Rebuck H, Mitchell SE, Miller M, Bagchi S. Association of Lipoprotein (a) with peri-coronary inflammation in persons with and without HIV infection. J Clin Lipidol 2024:S1933-2874(24)00024-2. [PMID: 38403541 DOI: 10.1016/j.jacl.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/21/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Persons with HIV (PWH) have an increased risk of developing cardiovascular disease (CVD) compared to persons without HIV (PWoH). Lipoprotein a (Lp(a)) is a known atherosclerotic risk factor in PWoH, but there are no studies investigating Lp(a) and peri-coronary inflammation. OBJECTIVE To investigate whether Lp(a) is associated with peri-coronary inflammation as assessed by the fat attenuation index (FAI) and activated monocytes and T lymphocytes in PWH and PWoH. METHODS We measured plasma levels of Lp(a) at study entry in 58 PWH and 21 PWoH without CVD and who had FAI measurements. Associations of Lp(a) with FAI values of the right coronary artery (RCA) and left anterior descending artery (LAD) were evaluated using multivariable regression models adjusted for potential confounders. Correlations between Lp(a) levels and systemic inflammatory markers and immune cell subsets were examined. RESULTS Lp(a) was associated with greater peri-coronary inflammation among PWH compared to PWoH (β=1.73, P=0.019) in the RCA, in adjusted models. Significant correlations were observed with certain inflammatory markers (TNFR-I, b=0.295, P<0.001; TNFR-II, b=0.270, P=0.002; hs-CRP, b=0.195, P=0.028). Significant correlations were found between Lp(a) levels and several markers of monocyte activation: CD16 -CD163+ (b= -0.199, P=0.024), and CD16 -DR+ MFI (b= -0.179, P=0.042) and T cell subset CD38+CD4+ TEMRA (b= 0.177, P= 0.044). CONCLUSIONS Lp(a) was associated with greater peri-coronary inflammation in the RCA in PWH compared to PWoH, as well as with select systemic inflammatory markers and specific subsets of immune cells in peripheral circulation.
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Affiliation(s)
- Erin Zisman
- University of Maryland School of Medicine, Department of Medicine, Baltimore, MD, USA (Dr Zisman)
| | - Mian Hossain
- Morgan State University, School of Community Health and Policy, Department of Statistics, Baltimore, MD, USA (Dr Hossain)
| | - Nicholas T Funderburg
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Medical Laboratory Science, Columbus, OH, USA (Dr Funderburg)
| | - Robert Christenson
- University of Maryland School of Medicine, Department of Pathology, Baltimore, MD, USA (Drs Christenson, Rebuck)
| | - Jean Jeudy
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA (Dr Jeudy)
| | - Shana Burrowes
- Boston University School of Medicine, Department of Medicine, Section of Infectious Diseases, Boston, MA, USA (Dr Burrowes)
| | - Allison G Hays
- Johns Hopkins University, Department of Medicine, Division of Cardiology, Baltimore, MD, USA (Dr Hays)
| | - Nivya George
- University of Maryland School of Medicine, Institute of Human Virology (Drs George, Mitchell)
| | - Michael L Freeman
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, OH, USA (Dr Freeman)
| | - Heather Rebuck
- University of Maryland School of Medicine, Department of Pathology, Baltimore, MD, USA (Drs Christenson, Rebuck)
| | - Sarah E Mitchell
- University of Maryland School of Medicine, Institute of Human Virology (Drs George, Mitchell)
| | - Michael Miller
- Corporal Michael J. Crescenz VA Medical Center & Hospital of the University of Pennsylvania, Department of Medicine, Philadelphia, PA, USA (Dr Miller)
| | - Shashwatee Bagchi
- Washington University in St. Louis, Division of Infectious Diseases, St. Louis, MO, USA (Dr Bagchi).
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13
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Wang G, Jing M, Xi H, Lei F, Ren W, Zhou J. Association of mean pericoronary adipose tissue attenuation with different demographic factors in a subgroup of patients without coronary artery disease stratified by sex, body mass index, and age. Quant Imaging Med Surg 2024; 14:503-513. [PMID: 38223068 PMCID: PMC10784090 DOI: 10.21037/qims-23-951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/03/2023] [Indexed: 01/16/2024]
Abstract
Background In patients without coronary artery disease (CAD), few studies have evaluated the association between mean pericoronary adipose tissue attenuation (PCATMA) and patient-based demographic factors, for example, age or sex. Therefore, the purpose of this study is to investigate the association between PCATMA and various demographic factors in patients without CAD. Methods In this case-control study, the 806 patients who underwent coronary computed tomography angiography and were not diagnosed with CAD between July 2020 and July 2022 were retrospectively enrolled. Their PCATMA values of the proximal right coronary artery were measured automatically. Patients without CAD were stratified according to sex, body mass index (BMI), and age, and the relationship between PCATMA and different clinical characteristics was explored using Fisher's exact test or Chi-squared test and independent t-tests or Wilcoxon Mann-Whitney U tests. Results Compared to non-smoking women [-88.00 (-95.00, -81.00) HU], women who smoked [-84.00 (-94.00, -78.00) HU, P=0.037] had higher PCATMA values and a positive correlation with PCATMA (rs=0.101, P=0.036). Compared to non-hypertensive patients with BMI ≥24.91 kg/m2 [-87.00 (-95.00, -81.00) HU], hypertensive patients with BMI ≥24.91 kg/m2 [-84.00 (-92.00, -78.00) HU, P=0.004] had higher PCATMA values, and a positive correlation with PCATMA (rs=0.144, P=0.004). In a subgroup of patients without CAD stratified by sex, BMI, and age, PCATMA values were all higher in patients with dyslipidemia (women, men, BMI ≥24.91 kg/m2, BMI <24.91 kg/m2, age ≥55 years, and age <55 years: -82.00, -82.00, -81.50, -82.00, -81.00 and -83.50 HU, respectively) than in those without dyslipidemia (-89.00, -89.00, -89.00, -90.00, -90.00 and -88.00 HU, respectively; all P<0.001) and showed a positive relationship (rs=0.328, 0.339, 0.342, 0.326, 0.367, and 0.298, respectively; all P<0.001). Conclusions Higher PCATMA attenuation values were observed in patients with dyslipidemia, smoking women, and hypertensive patients with BMI ≥24.91 kg/m2, suggesting that PCATMA values can be used to detect patients at high risk for future events with CAD even if they do not currently have atherosclerosis.
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Affiliation(s)
- Gang Wang
- Department of Radiology, First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
| | - Mengyuan Jing
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Huaze Xi
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Feng Lei
- Department of Radiology, First Hospital of Lanzhou University, Lanzhou, China
| | - Wei Ren
- GE Healthcare, Computed Tomography Research Center, Beijing, China
| | - Junlin Zhou
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
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14
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Vecsey-Nagy M, Kolossváry M, Varga-Szemes A, Boussoussou M, Vattay B, Nagy M, Juhász D, Merkely B, Radovits T, Szilveszter B. Low-attenuation coronary plaque burden and troponin release in chronic coronary syndrome: A mediation analysis. J Cardiovasc Comput Tomogr 2024; 18:18-25. [PMID: 37867127 DOI: 10.1016/j.jcct.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/01/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Coronary low-attenuation plaque (LAP) burden is a strong predictor of myocardial infarction in patients with stable chest pain. We aimed to assess the relationship between LAP burden and circulating levels of high-sensitivity cardiac troponin T (hs-cTnT), and to explore the potential underlying etiology in patients undergoing clinically indicated coronary CT angiography (CCTA). METHODS A comprehensive metabolic and lipid panel, as well as C-reactive protein (CRP) and hs-cTnT tests were obtained from consecutive patients with stable chest pain at the time of CCTA. Qualitative and quantitative coronary plaque analysis, CT-derived fractional flow reserve (FFR) calculation, and pericoronary adipose tissue (PCAT) attenuation measurement around the right coronary artery were performed on CCTA images. Linear regression analyses were performed to identify independent associations with hs-cTnT concentration and mediation analysis was used to assess whether ischemia or markers of inflammation mediate hs-cTnT elevation. RESULTS In total, 114 patients (56.3 ± 10.6 years, 44.7 % female) were enrolled. In multivariable analysis, age (β = 0.04 [95%CI: 0.02; 0.06], p < 0.001), female sex (β = -0.77 [95%CI: -1.20; 0.33], p < 0.001), and LAP burden (β = 0.03 [95%CI: 0.001; 0.06], p = 0.04) were independently associated with hs-cTnT levels. Mediation analysis, on the other hand, did not identify a significant mediating effect of lesion-specific ischemia based on CT-FFR, circulating CRP levels, or PCAT values between LAP burden and hs-cTnT levels (all p > 0.05). CONCLUSION Although ischemia and inflammation have previously been proposed to mediate the association between LAP burden and hs-cTnT levels, our results did not confirm the role of these pathophysiological pathways in patients with stable chest pain.
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Affiliation(s)
- Milán Vecsey-Nagy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
| | - Márton Kolossváry
- Gottsegen National Cardiovascular Center, Budapest, Hungary; Physiological Controls Research Center, Budapest, Hungary
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | | | - Borbála Vattay
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Martin Nagy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dénes Juhász
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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15
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Foldyna B, Mayrhofer T, Zanni MV, Lyass A, Barve R, Karady J, McCallum S, Burdo TH, Fitch KV, Paradis K, Fulda ES, Diggs MR, Bloomfield GS, Malvestutto CD, Fichtenbaum CJ, Aberg JA, Currier JS, Ribaudo HJ, Hoffmann U, Lu MT, Douglas PS, Grinspoon SK. Pericoronary Adipose Tissue Density, Inflammation, and Subclinical Coronary Artery Disease Among People With HIV in the REPRIEVE Cohort. Clin Infect Dis 2023; 77:1676-1686. [PMID: 37439633 PMCID: PMC10724469 DOI: 10.1093/cid/ciad419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Pericoronary adipose tissue (PCAT) may influence plaque development through inflammatory mechanisms. We assessed PCAT density, as a measure of pericoronary inflammation, in relationship to coronary plaque among people with human immunodeficiency virus (HIV [PWH]) and to a matched control population. METHODS In this baseline analysis of 727 participants of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) Mechanistic Substudy, we related computed tomography-derived PCAT density to presence and extent (Leaman score) of coronary artery disease (CAD), noncalcified plaque, coronary artery calcium (CAC), and vulnerable plaque features using multivariable logistic regression analyses. We further compared the PCAT density between PWH and age, sex, body mass index, CAC score, and statin use-matched controls from the community-based Framingham Heart Study (N = 464), adjusting for relevant clinical covariates. RESULTS Among 727 REPRIEVE participants (age 50.8 ± 5.8 years; 83.6% [608/727] male), PCAT density was higher in those with (vs without) coronary plaque, noncalcified plaque, CAC >0, vulnerable plaque, and high CAD burden (Leaman score >5) (P < .001 for each comparison). PCAT density related to prevalent coronary plaque (adjusted odds ratio [per 10 HU]: 1.44; 95% confidence interval, 1.22-1.70; P < .001), adjusted for clinical cardiovascular risk factors, body mass index, and systemic immune/inflammatory biomarkers. Similarly, PCAT density related to CAC >0, noncalcified plaque, vulnerable plaque, and Leaman score >5 (all P ≤ .002). PCAT density was greater among REPRIEVE participants versus Framingham Heart Study (-88.2 ± 0.5 HU versus -90.6 ± 0.4 HU; P < .001). CONCLUSIONS Among PWH in REPRIEVE, a large primary cardiovascular disease prevention cohort, increased PCAT density independently associated with prevalence and severity of coronary plaque, linking increased coronary inflammation to CAD in PWH.
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Affiliation(s)
- Borek Foldyna
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Mayrhofer
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Health Economics, School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Markella V Zanni
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Asya Lyass
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, USA
| | - Radhika Barve
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Karady
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sara McCallum
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tricia H Burdo
- Department of Microbiology, Immunology, and Inflammation and Center for NeuroVirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kathleen V Fitch
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kayla Paradis
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Evelynne S Fulda
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Marissa R Diggs
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Gerald S Bloomfield
- Department of Medicine, Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Carlos D Malvestutto
- Division of Infectious Diseases, Ohio State University Medical Center, Columbus, Ohio, USA
| | - Carl J Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Judith S Currier
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Heather J Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Udo Hoffmann
- Innovative Imaging Consulting LLC, Waltham, Massachusetts, USA
| | - Michael T Lu
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela S Douglas
- Department of Medicine (Cardiology), Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven K Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Stangret A, Dykacz W, Jabłoński K, Wesołowska A, Klimczak-Tomaniak D, Kochman J, Tomaniak M. The cytokine trio - visfatin, placental growth factor and fractalkine - and their role in myocardial infarction with non-obstructive coronary arteries (MINOCA). Cytokine Growth Factor Rev 2023; 74:76-85. [PMID: 37679252 DOI: 10.1016/j.cytogfr.2023.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) remains a puzzling clinical entity. It is characterized by clinical evidence of myocardial infarction (MI) with normal or near-normal coronary arteries in angiography. Given the complex etiology including multiple possible scenarios with varied pathogenetic mechanisms, profound investigation of the plausible biomarkers of MINOCA may bring further pathophysiological insights and novel diagnostic opportunities. Cytokines have a great diagnostic potential and are used as biomarkers for many diseases. An unusual trio of visfatin, placental growth factor (PlGF) and fractalkine (CX3CL1) can directly promote vascular dysfunction, inflammation and angiogenesis through the activation of the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling. They are redundant in physiological processes and become overexpressed in the pathomechanisms underlying MINOCA. The knowledge about their concentration might serve as a valuable diagnostic and/or therapeutic tool for assessing vascular endothelial function. Here we analyze the current knowledge on visfatin, PlGF and CX3CL1 in the context of MINOCA and present the novel clinical implications of their combined expression as predictors or indicators of this condition.
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Affiliation(s)
- Aleksandra Stangret
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum Cardinal Stefan Wyszynski University in Warsaw, Wóycickiego 1/3, 01-938 Warsaw, Poland; College of Medical Sciences, Nicolaus Copernicus Superior School, Nowogrodzka 47a, 00-695 Warsaw, Poland
| | - Weronika Dykacz
- First Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Konrad Jabłoński
- First Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Aleksandra Wesołowska
- First Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Dominika Klimczak-Tomaniak
- Department of Cardiology, Hypertension and Internal Medicine, Medical University of Warsaw, Warsaw, Poland; Department of Immunology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- First Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Mariusz Tomaniak
- First Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland.
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17
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Aromiwura AA, Settle T, Umer M, Joshi J, Shotwell M, Mattumpuram J, Vorla M, Sztukowska M, Contractor S, Amini A, Kalra DK. Artificial intelligence in cardiac computed tomography. Prog Cardiovasc Dis 2023; 81:54-77. [PMID: 37689230 DOI: 10.1016/j.pcad.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
Artificial Intelligence (AI) is a broad discipline of computer science and engineering. Modern application of AI encompasses intelligent models and algorithms for automated data analysis and processing, data generation, and prediction with applications in visual perception, speech understanding, and language translation. AI in healthcare uses machine learning (ML) and other predictive analytical techniques to help sort through vast amounts of data and generate outputs that aid in diagnosis, clinical decision support, workflow automation, and prognostication. Coronary computed tomography angiography (CCTA) is an ideal union for these applications due to vast amounts of data generation and analysis during cardiac segmentation, coronary calcium scoring, plaque quantification, adipose tissue quantification, peri-operative planning, fractional flow reserve quantification, and cardiac event prediction. In the past 5 years, there has been an exponential increase in the number of studies exploring the use of AI for cardiac computed tomography (CT) image acquisition, de-noising, analysis, and prognosis. Beyond image processing, AI has also been applied to improve the imaging workflow in areas such as patient scheduling, urgent result notification, report generation, and report communication. In this review, we discuss algorithms applicable to AI and radiomic analysis; we then present a summary of current and emerging clinical applications of AI in cardiac CT. We conclude with AI's advantages and limitations in this new field.
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Affiliation(s)
| | - Tyler Settle
- Medical Imaging Laboratory, Department of Electrical and Computer Engineering, University of Louisville, Louisville, KY, USA
| | - Muhammad Umer
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Jonathan Joshi
- Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA
| | - Matthew Shotwell
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Jishanth Mattumpuram
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Mounica Vorla
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Maryta Sztukowska
- Clinical Trials Unit, University of Louisville, Louisville, KY, USA; University of Information Technology and Management, Rzeszow, Poland
| | - Sohail Contractor
- Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA
| | - Amir Amini
- Medical Imaging Laboratory, Department of Electrical and Computer Engineering, University of Louisville, Louisville, KY, USA; Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA
| | - Dinesh K Kalra
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA; Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA.
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18
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Jaltotage B, Sukudom S, Ihdayhid AR, Dwivedi G. Enhancing Risk Stratification on Coronary Computed Tomography Angiography: The Role of Artificial Intelligence. Clin Ther 2023; 45:1023-1028. [PMID: 37813776 DOI: 10.1016/j.clinthera.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE To describe and outline the role of artificial intelligence (AI) in assisting coronary computed tomography angiography (CCTA) in enhancing risk stratification. METHODS A comprehensive review of the literature was performed to identify published work investigating the utility of applying AI to CCTA. FINDINGS CCTA is an excellent diagnostic tool for the detection of atherosclerotic cardiovascular disease. The noninvasive nature and high diagnostic accuracy have made CCTA a viable alternative to invasive coronary angiography to detect luminal stenosis. However, it is now understood that stenosis is just one factor that predicts cardiac risk and other factors need to be considered. CCTA-derived plaque biomarkers have since emerged as established predictors of cardiac events to improve risk stratification. Despite awareness of these biomarkers, they are still yet to be incorporated into routine clinical practice. The major barriers to implementation include the specialized skills required for image evaluation and the time intensive nature of analysis. With the many recent advancements in the technology, AI presents itself as a promising solution. AI is attractive because it has the potential to rapidly automate technically challenging tasks with exceptional accuracy. IMPLICATIONS Developments in the field of AI are occurring at a rapid rate. There is already increasing evidence of the potential AI has to greatly improve the utility of CCTA by improving analysis time and extracting additional prognostic data from new plaque biomarkers. There are, however, technical and ethical challenges that need to be considered before implementing such technology into routine clinical practice.
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Affiliation(s)
| | - Sara Sukudom
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, School of Medicine, University of Western Australia, Perth, Australia
| | - Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, School of Medicine, University of Western Australia, Perth, Australia; School of Medicine, Curtin University, Perth, Australia
| | - Girish Dwivedi
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia; Harry Perkins Institute of Medical Research, School of Medicine, University of Western Australia, Perth, Australia.
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19
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Thompson PL, Hamzah J. Atherosclerosis: More Challenging and Complex Than We Thought. Clin Ther 2023; 45:1017-1018. [PMID: 37932153 DOI: 10.1016/j.clinthera.2023.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Peter L Thompson
- Harry Perkins Institute of Medical Research, Nedlunds, Western Australia, Australia; University of Western Australia, Crawley, Western Australia, Australia; Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Juliana Hamzah
- Harry Perkins Institute of Medical Research, Nedlunds, Western Australia, Australia; Curtin University, Bentley, Perth, Western Australia, Australia
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20
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Qi M, Janssen I, Barinas-Mitchell E, Budoff M, Brooks MM, Karlamangla AS, Derby CA, Chang CCH, Shields KJ, El Khoudary SR. The quantity and quality of cardiovascular fat at mid-life and future cognitive performance among women: The SWAN cardiovascular fat ancillary study. Alzheimers Dement 2023; 19:4073-4083. [PMID: 37212597 DOI: 10.1002/alz.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Cardiovascular fat is a novel risk factor that may link to dementia. Fat volume and radiodensity are measurements of fat quantity and quality, respectively. Importantly, high fat radiodensity could indicate healthy or adverse metabolic processes. METHODS The associations of cardiovascular fat (including epicardial, paracardial, and thoracic perivascular adipose tissue [PVAT]) quantity and quality assessed at mean age of 51 with subsequent cognitive performance measured repeatedly over 16 years of follow-up were examined using mixed models among 531 women. RESULTS Higher thoracic PVAT volume was associated with a higher future episodic memory (β[standard error (SE)] = 0.08 [0.04], P = 0.033), while higher thoracic PVAT radiodensity with lower future episodic (β[SE] = -0.06 [0.03], P = 0.045) and working (β[SE] = -0.24 [0.08], P = 0.003) memories. The latter association is prominent at higher volume of thoracic PVAT. DISCUSSION Mid-life thoracic PVAT may have a distinct contribution to future cognition possibly due to its distinct adipose tissue type (brown fat) and anatomical proximity to the brain circulation. HIGHLIGHTS Higher mid-life thoracic perivascular adipose tissue (thoracic PVAT) volume is related to a better future episodic memory in women. Higher mid-life thoracic PVAT radiodensity is related to worse future working and episodic memories. Negative association of high thoracic PVAT radiodensity with working memory is prominent at higher thoracic PVAT volume. Mid-life thoracic PVAT is linked to future memory loss, an early sign of Alzheimer's disease. Mid-life women's epicardial and paracardial fat are not related to future cognition.
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Affiliation(s)
- Meiyuzhen Qi
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Rush Medical Center, Chicago, Illinois, USA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Matthew Budoff
- Harbor-UCLA Medical Center, Lundquist Institute, Torrance, California, USA
| | - Maria M Brooks
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Arun S Karlamangla
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Carol A Derby
- Albert Einstein College of Medicine Department of Neurology and Department of Epidemiology & Public Health, Bronx, New York, USA
| | - Chung-Chou H Chang
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | | | - Samar R El Khoudary
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
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21
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Freeman ML, Hossain MB, Burrowes SAB, Jeudy J, Bui R, Moisi D, Mitchell SE, Khambaty M, Weiss RG, Lederman MM, Bagchi S. Association of Soluble Markers of Inflammation With Peri-coronary Artery Inflammation in People With and Without HIV Infection and Without Cardiovascular Disease. Open Forum Infect Dis 2023; 10:ofad328. [PMID: 37636516 PMCID: PMC10460251 DOI: 10.1093/ofid/ofad328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/23/2023] [Indexed: 08/29/2023] Open
Abstract
Background Inflammation is linked to elevated cardiovascular disease (CVD) risk in people with HIV (PWH) on antiretroviral therapy (ART). Fat attenuation index (FAI) is a measure of peri-coronary inflammation that independently predicts CVD risk in HIV-uninfected persons. Whether FAI is associated with soluble inflammatory markers is unknown. Methods Plasma levels of inflammatory markers were measured in 58 PWH and 16 controls without current symptoms or prior known CVD who underwent coronary computed tomography angiography and had FAI measurements. A cross-sectional analysis was performed, and associations of markers with FAI values of the right coronary artery (RCA) and left anterior descending artery (LAD) were assessed using multivariable regression models adjusted for the potential confounders age, sex, race, low-density lipoprotein cholesterol, body mass index, and use of lipid-lowering medication. Results Several inflammatory markers had significant associations with RCA or LAD FAI in adjusted models, including sCD14, sCD163, TNFR-I, and TNFR-II, CCL5, CX3CL1, IP-10. Conclusions The associations between indices of systemic and peri-coronary inflammation are novel and suggest that these systemic markers and FAI together are promising noninvasive biomarkers that can be applied to assess asymptomatic CVD in people with and without HIV; they also may be useful tools to evaluate effects of anti-inflammatory interventions.
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Affiliation(s)
- Michael L Freeman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mian B Hossain
- School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA
| | - Shana A B Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jean Jeudy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ryan Bui
- Center for Biostatistics and Data Science Institute for Informatics, Data Science & Biostatistics, Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniela Moisi
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sarah E Mitchell
- Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mariam Khambaty
- Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robert G Weiss
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Michael M Lederman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Shashwatee Bagchi
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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22
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Csecs I, Feher A. The fat and the flow: multiparametric imaging assessment of pericoronary adipose tissue and myocardial blood flow. J Nucl Cardiol 2023; 30:1570-1573. [PMID: 36929294 DOI: 10.1007/s12350-023-03247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Ibolya Csecs
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520, USA.
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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23
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Nogic J, Kim J, Layland J, Cheng K, Dey D, Wong DT, Cameron JD, Brown AJ. Peri-Coronary Adipose Tissue Is a Predictor of Stent Failure in Patients Undergoing Percutaneous Coronary Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53:61-66. [PMID: 36863976 DOI: 10.1016/j.carrev.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Coronary inflammation is postulated as a driver of atherosclerosis and dysfunctional arterial healing which may trigger stent failure. Pericoronary adipose tissue (PCAT) attenuation, detected on computer tomography coronary angiography (CTCA), is an emerging non-invasive marker of coronary inflammation. This propensity matched study assessed the utility of both lesion specific (PCATLesion) and standardized PCAT attenuation as assessed in the proximal RCA (PCATRCA) as a predictor of stent failure in patients undergoing elective percutaneous coronary intervention. This is the first study to our knowledge that assesses the association of PCAT with stent failure. METHODS Patients undergoing CTCA assessment for coronary artery disease with subsequent stent insertion within 60 days and repeat coronary angiography for any clinical reason within 5 years were included in the study. Stent failure was defined as binary restenosis of >50 % on quantitative coronary angiography analysis or stent thrombosis. Both PCATLesion and PCATRCA was assessed utilizing semi-automated proprietary software on baseline CTCA. Patients with stent failure were propensity matched utilizing age, sex, cardiovascular risk factors and procedural characteristics. RESULTS One hundred and fifty-one patients met inclusion criteria. Of these, 26 (17.2 %) had study-defined failure. A significant difference in PCATLesion attenuation between patients with and without failure was observed (-79.0 ± 12.6 vs. -85.9 ± 10.3HU, p = 0.035). There was no significant difference in PCATRCA attenuation between the two groups (-79.5 ± 10.1 vs -81.0 ± 12.3HU, p = 0.50). Univariate regression analysis showed PCATLesion attenuation was independently associated with stent failure (OR 1.06, 95 % CI 1.01-1.12, P = 0.035). CONCLUSIONS Patients with stent failure exhibit significantly increased PCATLesion attenuation at baseline. These data suggest that baseline plaque inflammation may be an important driver for coronary stent failure.
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Affiliation(s)
- Jason Nogic
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Australia.
| | - Jiwon Kim
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Australia
| | - Jamie Layland
- Cardiology, Department of Medicine, Peninsula Health, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kevin Cheng
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Australia
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States of America
| | - Dennis T Wong
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Australia
| | - James D Cameron
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Australia
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24
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Lin A, Pieszko K, Park C, Ignor K, Williams MC, Slomka P, Dey D. Artificial intelligence in cardiovascular imaging: enhancing image analysis and risk stratification. BJR Open 2023; 5:20220021. [PMID: 37396483 PMCID: PMC10311632 DOI: 10.1259/bjro.20220021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 03/14/2023] [Accepted: 04/03/2023] [Indexed: 07/04/2023] Open
Abstract
In this review, we summarize state-of-the-art artificial intelligence applications for non-invasive cardiovascular imaging modalities including CT, MRI, echocardiography, and nuclear myocardial perfusion imaging.
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Affiliation(s)
| | | | - Caroline Park
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Katarzyna Ignor
- Department of Interventional Cardiology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Piotr Slomka
- Division of Artificial Intelligence, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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25
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Li C, Liu X, Adhikari BK, Chen L, Liu W, Wang Y, Zhang H. The role of epicardial adipose tissue dysfunction in cardiovascular diseases: an overview of pathophysiology, evaluation, and management. Front Endocrinol (Lausanne) 2023; 14:1167952. [PMID: 37260440 PMCID: PMC10229094 DOI: 10.3389/fendo.2023.1167952] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/21/2023] [Indexed: 06/02/2023] Open
Abstract
In recent decades, the epicardial adipose tissue (EAT) has been at the forefront of scientific research because of its diverse role in the pathogenesis of cardiovascular diseases (CVDs). EAT lies between the myocardium and the visceral pericardium. The same microcirculation exists both in the epicardial fat and the myocardium. Under physiological circumstances, EAT serves as cushion and protects coronary arteries and myocardium from violent distortion and impact. In addition, EAT acts as an energy lipid source, thermoregulator, and endocrine organ. Under pathological conditions, EAT dysfunction promotes various CVDs progression in several ways. It seems that various secretions of the epicardial fat are responsible for myocardial metabolic disturbances and, finally, leads to CVDs. Therefore, EAT might be an early predictor of CVDs. Furthermore, different non-invasive imaging techniques have been proposed to identify and assess EAT as an important parameter to stratify the CVD risk. We also present the potential therapeutic possibilities aiming at modifying the function of EAT. This paper aims to provide overview of the potential role of EAT in CVDs, discuss different imaging techniques to assess EAT, and provide potential therapeutic options for EAT. Hence, EAT may represent as a potential predictor and a novel therapeutic target for management of CVDs in the future.
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Affiliation(s)
- Cheng Li
- Department of Cardiovascular Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xinyu Liu
- School of Basic Medical Sciences, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | | | - Liping Chen
- Department of Echocardiography, Cardiovascular Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Wenyun Liu
- Department of Radiology, The First Hospital of Jilin University, Jilin Provincial Key Laboratory of Medical Imaging and Big Data, Changchun, Jilin, China
| | - Yonggang Wang
- Department of Cardiovascular Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Huimao Zhang
- Department of Radiology, The First Hospital of Jilin University, Jilin Provincial Key Laboratory of Medical Imaging and Big Data, Changchun, Jilin, China
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Jing M, Xi H, Zhu H, Zhang B, Deng L, Han T, Zhang Y, Zhou J. Correlation of pericoronary adipose tissue CT attenuation values of plaques and periplaques with plaque characteristics. Clin Radiol 2023:S0009-9260(23)00172-1. [PMID: 37225572 DOI: 10.1016/j.crad.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/26/2023]
Abstract
AIM To investigate the relationship between different plaque characteristics and pericoronary adipose tissue (PCAT) computed tomography (CT) attenuation values for plaques and periplaques. MATERIALS AND METHODS The data from 188 eligible patients with stable coronary heart disease (280 lesions) who underwent coronary CT angiography between March 2021 and November 2021 were collected retrospectively. All PCAT CT attenuation values of plaques and periplaques (the area within 5 and 10 mm proximal and distal to the plaque) were calculated, and multiple linear regression was used to assess their correlation with different plaque characteristics. RESULTS PCAT CT attenuation of plaques and periplaques was higher in non-calcified plaques (-73.38 ± 10.41 HU, -76.77 ± 10.86 HU, 79.33 ± 11.13 HU, -75.67 ± 11.24 HU, -78.63 ± 12.09 HU) and mixed plaques (-76.83 ± 8.11 HU, -79 [-85, -68.5] HU, -78.55 ± 11 HU, -78.76 ± 9.9 HU, -78.79 ± 11.06 HU) than in calcified plaques (-86.96 ± 10 HU, -84 [-92, -76] HU, -84.14 ± 11.08 HU, -84.91 ± 11.41 HU, -84.59 ± 11.69 HU; all p<0.05) and higher in distal segment plaques than in proximal segment plaques (all p<0.05). Plaque PCAT CT attenuation was lower in plaques with minimal stenosis than in plaques with mild or moderate stenosis (p<0.05). The significant determinants of PCAT CT attenuation values of plaques and periplaques were non-calcified plaques, mixed plaques, and plaques located in the distal segment (all p<0.05). CONCLUSIONS PCAT CT attenuation values in both plaques and periplaques were related to plaque type and location.
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Affiliation(s)
- M Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - H Xi
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - H Zhu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - B Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - L Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - T Han
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Y Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - J Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
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Jing M, Sun J, Zhou Q, Sun J, Li X, Xi H, Zhang B, Lin X, Deng L, Han T, Zhou J. Pericoronary adipose tissue differences among plaque types: a retrospective assessment. Clin Imaging 2023; 96:58-63. [PMID: 36822014 DOI: 10.1016/j.clinimag.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Abstract
PURPOSE To assess differences in pericoronary adipose tissue (PCAT) in patients with different plaque types by using several quantitative parameters of PCAT and investigate the relationship between PCAT and different plaque types. MATERIALS AND METHODS We retrospectively recruited 488 patients diagnosed with stable coronary artery disease (CAD) via coronary computed tomographic angiography, including 279 with calcified plaques (CP), 153 with non-calcified plaques (NCP), and 56 with mixed plaques (MP). Volume, fat attenuation index (FAI), and 10th percentile, 90th percentile, median, and minimum Hounsfield unit (HU) values of PCAT surrounding plaques were quantified. Clinical features and quantitative PCAT parameters were compared between different plaque types. RESULTS No intergroup differences were observed for age, sex, body mass index, risk factors, and plaque location. Length and PCAT volume in the NCP group were lower than those of the CP and MP groups (P < 0.001), whereas there were no significant differences between the CP and MP groups (P > 0.05). Patients with NCP and MP had a higher FAI and 10th percentile, 90th percentile, median, and minimum HU values of PCAT than CP (P < 0.001); however these values were not significantly different between the NCP and MP groups (P > 0.05). CONCLUSION The quantitative parameters of PCAT, as a biosensor for CAD, vary among the different plaque types.
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Affiliation(s)
- Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Jianqing Sun
- Shanghai United Imaging Research Institute of Intelligent Imaging, Shanghai, China
| | - Qing Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Jiachen Sun
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Xiangwen Li
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Huaze Xi
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Bin Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Xiaoqiang Lin
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Liangna Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Tao Han
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
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Okamoto S, Mochizuki J, Matsumi H, Hashimoto K, Nikaido A, Hata Y. Perivascular fat attenuation index measured by coronary computed tomography angiography as a tool for assessment of ischaemia-causing lesions: a case report. BMC Cardiovasc Disord 2023; 23:140. [PMID: 36934235 PMCID: PMC10024373 DOI: 10.1186/s12872-023-03177-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/09/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND It can be difficult to diagnose coronary artery disease in patients with acute coronary syndrome if coronary angiography does not identify stenosis. Coronary inflammation, which can contribute to the pathogenesis of coronary artery disease and acute coronary syndrome, can be quantified using the perivascular fat attenuation index. Furthermore, the perivascular fat attenuation index is a marker for all-cause mortality, cardiac-related mortality and impaired global coronary flow reserve. CASE PRESENTATION Here we report a case of a patient presenting with symptoms of acute coronary syndrome. The patient had hypokinesis of the lateral-posterior wall of the left ventricle, decreased myocardial perfusion in the posterior wall myocardium and elevated myocardial troponin-T and creatine phosphokinase levels. However, coronary computed tomography angiography did not identify arterial stenosis. The patient did have an increased perivascular fat attenuation index, indicating coronary inflammation. Moreover, the fat attenuation index was higher around the left circumflex artery than around the right coronary artery or left anterior descending artery. Intravascular ultrasonography identified an intramural haematoma, leading to a diagnosis of type 3 spontaneous coronary artery dissection in the left circumflex artery. CONCLUSIONS Perivascular fat attenuation index may be a useful tool to help identify and localise disease-causing lesions, and to direct further testing to confirm a diagnosis of spontaneous coronary artery dissection in acute coronary syndrome patients without significant arterial stenosis.
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Affiliation(s)
- Shuichi Okamoto
- Department of Cardiovascular Medicine, Minamino Cardiovascular Hospital, 1-25-1 Hyoue, Hachiouji, Tokyo, 192-0918, Japan.
| | - Junji Mochizuki
- Department of Cardiovascular Medicine, Minamino Cardiovascular Hospital, 1-25-1 Hyoue, Hachiouji, Tokyo, 192-0918, Japan
| | - Hiroaki Matsumi
- Department of Cardiovascular Medicine, Minamino Cardiovascular Hospital, 1-25-1 Hyoue, Hachiouji, Tokyo, 192-0918, Japan
| | - Katsushi Hashimoto
- Department of Cardiovascular Medicine, Minamino Cardiovascular Hospital, 1-25-1 Hyoue, Hachiouji, Tokyo, 192-0918, Japan
| | - Akira Nikaido
- Department of Cardiovascular Medicine, Minamino Cardiovascular Hospital, 1-25-1 Hyoue, Hachiouji, Tokyo, 192-0918, Japan
| | - Yoshiki Hata
- Department of Cardiovascular Medicine, Minamino Cardiovascular Hospital, 1-25-1 Hyoue, Hachiouji, Tokyo, 192-0918, Japan
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Prediction of microvascular complications in diabetic patients without obstructive coronary stenosis based on peri-coronary adipose tissue attenuation model. Eur Radiol 2023; 33:2015-2026. [PMID: 36255489 DOI: 10.1007/s00330-022-09176-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/29/2022] [Accepted: 09/18/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the predictive value of peri-coronary adipose tissue (PCAT) attenuation for microvascular complications in diabetic patients without significant stenosis and to develop a prediction model for early risk stratification. METHODS This study retrospectively included patients clinically identified for coronary computed tomography angiography (CCTA) and type 2 diabetes between January 2017 and December 2020. All patients were followed up for at least 1 year. The clinical data and CCTA-based imaging characteristics (including PCAT of major epicardial vessels, high-risk plaque features) were recorded. In the training cohort comprising of 579 patients, two models were developed: model 1 with the inclusion of clinical factors and model 2 incorporating clinical factors + RCAPCAT using multivariable logistic regression analysis. An internal validation cohort comprising 249 patients and an independent external validation cohort of 269 patients were used to validate the proposed models. RESULTS Microvascular complications occurred in 69.1% (758/1097) of the current cohort during follow-up. In the training cohort, model 2 exhibited improved predictive power over model 1 based on clinical factors (AUC = 0.820 versus 0.781, p = 0.003) with lower prediction error (Brier score = 0.146 versus 0.164) compared to model 1. Model 2 accurately categorized 78.58% of patients with diabetic microvascular complications. Similar performance of model 2 in the internal validation cohort and the external validation cohort was further confirmed. CONCLUSIONS The model incorporating clinical factors and RCAPCAT predicts the development of microvascular complications in diabetic patients without significant coronary stenosis. KEY POINTS • Hypertension, HbA1c, duration of diabetes, and RCAPCAT were independent risk factors for microvascular complications. • The prediction model integrating RCAPCAT exhibited improved predictive power over the model only based on clinical factors (AUC = 0.820 versus 0.781, p = 0.003) and showed lower prediction error (Brier score=0.146 versus 0.164).
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To Explore the Influencing Factors of Pericoronary Adipose Tissue and Noninvasive Fractional Flow Reserve on the Progression of Coronary Heart Disease Based on 320-Slice Coronary CTA. Anatol J Cardiol 2023; 27:100-105. [PMID: 36747456 PMCID: PMC9900413 DOI: 10.14744/anatoljcardiol.2022.2576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The objective of the study was to measure pericoronal adipose tissue parameters, fractional flow reserve with coronary artery computed tomographic angiography (CTA), and difference of fractional flow reserve with coronary artery CTA, by using high-performance 320-slice coronary CTA combined with semiautomatic quantitative software and explore the relationship between them and progression of coronary artery disease. METHODS According to the inclusion criteria, 118 patients with complete data were selected. According to the results of coronary angiography during follow-up review, the patients were divided into coronary artery disease progression group (n = 43) and coronary artery disease stable group (n = 75), and the clinical baseline data, pericoronal adipose tissue volume, pericoronal adipose tissue fat attenuation index, fractional flow reserve with coronary artery CTA, and difference of fractional flow reserve with coronary artery CTA were compared between the 2 groups. According to univariate and multivariate logistic regression analyses, the risk factors related to coronary artery disease progression were screened out from pericoronal adipose tissue parameters and noninvasive hemodynamic characteristics (fractional flow reserve with coronary artery CTA and difference of fractional flow reserve with coronary artery CTA). RESULTS There was no significant difference in baseline clinical data between the progression group and the stable group (P >.05). The left anterior descending artery-fat attenuation index-40 mm, left anterior descending artery-fat attenuation index-70 mm, left circumflex artery-fat attenuation index-70 mm, right coronary artery-fat attenuation index-70 mm, and difference of fractional flow reserve with coronary artery CTA in the progression group were higher than those in the stable group, while fractional flow reserve with coronary artery CTA was lower than that in the stable group, and the differences were statistically significant (P <.05). After adjusting for several factors, the results showed that left anterior descending artery-fat attenuation index-40 mm (P =.002; odds ratio = 1.237; 95% CI: 1.081-1.415), right coronary artery-fat attenuation index-70 mm (P =.039; odds ratio = 1.119; 95% CI: 1.006-1.246), fractional flow reserve with coronary artery CTA (P =.001; odds ratio = 0.708; 95% CI: 0.581-0.846), and difference of fractional flow reserve with coronary artery CTA (P <.001; odds ratio = 1.846; 95% CI: 1.394-2.445) were related to the progression of coronary artery disease. Compared with the above 5 indicators, the area under curve (AUC) of the above indicators combined is larger (0.897). CONCLUSIONS Quantitative pericoronal adipose tissue parameters and noninvasive hemodynamic characteristics based on 320-slice coronary CTA can be used as the basis for predicting the progression of coronary artery disease.
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Berman DS, Lin A. Artificial Intelligence for Assessment of Epicardial Adipose Tissue on Coronary CT Angiography. JACC Cardiovasc Imaging 2023:S1936-878X(22)00731-8. [PMID: 36881422 DOI: 10.1016/j.jcmg.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 02/11/2023]
Affiliation(s)
- Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| | - Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Melbourne, Australia
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Farag SI, Mostafa SA, El-Rabbat KE, El-Kaffas SM, Awara DM. The relation between pericoronary fat thickness and density quantified by coronary computed tomography angiography with coronary artery disease severity. Indian Heart J 2023; 75:53-58. [PMID: 36640839 PMCID: PMC9986735 DOI: 10.1016/j.ihj.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To study the correlation between epicardial fat thickness (EFT), pericoronary fat thickness (PCFT), and pericoronary fat density (PCFD) with the existence and severity of coronary artery disease (CAD). METHODS This cross-sectional study included 210 patients referred for multislice CT angiography. Group I normal CTCA, Group II patients had non-obstructive atherosclerosis, and Group III patients had obstructive atherosclerosis. All patients underwent a clinical examination, history taking, and multislice CT angiography. RESULTS The mean EFT was significantly greater in group III (10.43 ± 2.31 mm) compared to groups II (6.30 ± 1.61 mm) and I (5.06 ± 1.14 mm). The mean PCFT was significantly greater in group III (17.96 ± 2.89 mm) compared to group II (11.47 ± 2.51 mm) and group I (9.67 ± 1.99 mm). PCFD was significantly higher adjacent to the lesion (-80.47 ± 29.14) compared to the normal segment (-109.03 ± 35.24), higher in the obstructive group (-59.44 ± 20.10) compared to the non-obstructive group (-101.51 ± 20.23), but lower in calcified lesions (-89.58 ± 28.94) compared to non-calcified (-75.01 ± 29.20), and mixed lesions (-74.83 ± 26.90). EFT and PCFT cut-off values for predicting obstructive CAD were 8.3 and 12.4 mm, respectively, with 87.1% and 92.9% sensitivity and 92.9% and 86.4% specificity, respectively. CONCLUSION There is a significant association between epicardial fat thickness, pericoronary fat thickness and density with the severity of coronary artery disease.
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Affiliation(s)
- Shereen I Farag
- Cardiovascular Medicine Department, Faculty of Medicine, Benha University, Egypt.
| | - Shaimaa A Mostafa
- Cardiovascular Medicine Department, Faculty of Medicine, Benha University, Egypt
| | - Khaled E El-Rabbat
- Cardiovascular Medicine Department, Faculty of Medicine, Benha University, Egypt
| | - Sameh M El-Kaffas
- Cardiovascular Medicine Department, Faculty of Medicine, Cairo University, Egypt
| | - Dalia M Awara
- Cardiovascular Medicine Department, Faculty of Medicine, Benha University, Egypt
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Chatterjee D, Shou BL, Matheson MB, Ostovaneh MR, Rochitte C, Chen MY, Dewey M, Ortman J, Cox C, Lima JAC, Arbab-Zadeh A. Perivascular fat attenuation for predicting adverse cardiac events in stable patients undergoing invasive coronary angiography. J Cardiovasc Comput Tomogr 2022; 16:483-490. [PMID: 35680534 PMCID: PMC9684349 DOI: 10.1016/j.jcct.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 12/24/2022]
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.
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Affiliation(s)
- Devina Chatterjee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Benjamin L Shou
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Carlos Rochitte
- InCor Heart Institute, University of São Paulo Medical School, Brazil, São Paulo, Brazil
| | - Marcus Y Chen
- Cardiology Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marc Dewey
- Charité Medical School-Humboldt, Berlin, Germany
| | - Jason Ortman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher Cox
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joao A C Lima
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sagris M, Antonopoulos AS, Simantiris S, Oikonomou E, Siasos G, Tsioufis K, Tousoulis D. Pericoronary fat attenuation index-a new imaging biomarker and its diagnostic and prognostic utility: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2022; 23:e526-e536. [PMID: 36069510 PMCID: PMC9840478 DOI: 10.1093/ehjci/jeac174] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/08/2022] [Indexed: 01/19/2023] Open
Abstract
Pericoronary fat attenuation index (FAI) on coronary computed tomography angiography imaging has been proposed as a novel marker of coronary vascular inflammation with prognostic value for major cardiovascular events. To date, there is no systematic review of the published literature and no meta-analysed data of previously published results. We performed a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We systematically explored published literature in MEDLINE (PubMed) before 20 January 2022 for studies assessing FAI in both diagnostic and prognostic clinical settings in patients with or without cardiovascular disease. The primary outcome was the mean difference in FAI attenuation between stable and unstable coronary plaques. The secondary outcome was the hazard ratio (HR) of high FAI values for future cardiovascular events. We calculated I2 to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcomes. This study is registered with PROSPERO (CRD42021229491). In total, 20 studies referred in a total of 7797 patients were included in this systematic review, while nine studies were used for the meta-analysis. FAI was significantly higher in unstable compared with stable plaques with a mean difference of 4.50 Hounsfield units [95% confidence interval (CI): 1.10-7.89, I2 = 88%] among 902 patients. Higher pericoronary FAI values offered incremental prognostic value for major adverse cardiovascular events (MACEs) in studies with prospective follow-up (HR = 3.29, 95% CI: 1.88-5.76, I2 = 75%) among 6335 patients. Pericoronary FAI seems to be a promising imaging biomarker that can be used for the detection of coronary inflammation, possibly to discriminate between stable and unstable plaques, and inform on the prognosis for future MACE. Further validation of these findings and exploration of the cost-effectiveness of the method before implementation in clinical practice are needed.
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Affiliation(s)
| | - Alexios S Antonopoulos
- First Cardiology Clinic, School of Medicine, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece,Centre for Clinical, Experimental Surgery & Translational Research, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou, 115 27 Athens, Greece
| | - Spiridon Simantiris
- First Cardiology Clinic, School of Medicine, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece
| | - Evangelos Oikonomou
- First Cardiology Clinic, School of Medicine, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece
| | - Gerasimos Siasos
- First Cardiology Clinic, School of Medicine, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece,Harvard Medical School, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Konstantinos Tsioufis
- First Cardiology Clinic, School of Medicine, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Clinic, School of Medicine, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece
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Association of Obstructive Sleep Apnea Syndrome (OSA/OSAHS) with Coronary Atherosclerosis Risk: Systematic Review and Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8905736. [PMID: 36035275 PMCID: PMC9402316 DOI: 10.1155/2022/8905736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
Abstract
Objective Obstructive sleep apnea syndrome (OSA) is the most common type of sleep disorders. This study aimed to systematically review the correlation between OSA and the risk of coronary atherosclerosis. Methods Literature on case-control studies on the relationship between coronary heart disease (CHD) and sleep apnea syndrome was collected and collated, and the incidence of SAS in CHD and non-CHD patients was observed and compared. RevMan 5.2 analysis software and Stata12SE analysis software were used for heterogeneity test and combination analysis of the included studies. The results were expressed with odds ratio (OR), 95% confidence intervals (CI) were calculated, and publication bias and sensitivity tests were evaluated. Results There was a statistical difference in OSA associated with the risk of coronary atherosclerosis between the experimental group and the control group [OR = 1.38, 95% CI (1.18, 1.62), P < 0.0001, I 2 = 0%, Z = 3.93]. OSA associated with vascular endothelial injury [OR = 3.59, 95% CI (3.00, 4.29), P < 0.00001, I 2 = 90%, Z = 14.09]. OSA is associated with vascular oxidation emergency [OR = 2.19, 95% CI (2.05, 2.33), P < 0.00001, I 2 = 94%, Z = 23.40]; OSA is associated with chronic vascular inflammation [OR = 1.70, 95% CI (1.39, 2.07), P < 0.00001, I 2 = 16%, Z = 5.18]. Conclusion The incidence of obstructive sleep apnea in patients with CHD was higher than that in non-CHD patients, and obstructive sleep apnea was a risk factor for CHD.
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Goel V, Spear E, Cameron W, Thakur U, Sultana N, Chan J, Tan S, Joshi M, Roberts A, Cheen YC, Youn H, Dey D, Davis E, Nicholls S, Brown A, Nerlekar N. Breast arterial calcification and epicardial adipose tissue volume, but not density are independently associated with cardiovascular risk. Int J Cardiol 2022; 360:78-82. [PMID: 35618106 DOI: 10.1016/j.ijcard.2022.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/14/2022] [Accepted: 05/20/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mammographically detected breast arterial calcification (BAC) has been proposed as surrogate marker for coronary artery disease (CAD) in women. Epicardial adipose tissue (EAT) and peri-coronary adipose tissue (PCAT) are inflammatory fat depots linked to atherogenesis. BAC has demonstrated association with inflammation, therefore we aimed to determine the association between BAC, EAT and PCAT. METHODS Single-centre, retrospective, cross-sectional study of women with digital mammography and coronary computed tomography angiography (CCTA). EAT and PCAT were quantitively assessed using semi-automated software. Patient demographics and cardiovascular risk factors were obtained from medical records and mammograms reviewed for BAC. Pre-test cardiovascular risk was determined with CAD Consortium Score. Chi-square, t-test and Mann-Whitney U tests were used to assess between group differences. Multivariable linear and logistic regression modelling was conducted to adjust for confounders. RESULTS Among 153 patients (age 61, SD 11) included in this study, BAC was present in 37 (24%) patients. BAC-positive patients had higher EAT volume (EATv) (110.2 mL, SD 41 mL vs 94.4 mL, SD 41 mL, p = 0.02) but this association was not significant after adjusting for cardiovascular risk factors (p = 0.26). BAC did not associate with EAT density or PCAT. BAC and EATv were strongly associated with cardiovascular risk and CAD independent of each other: CV risk (BAC OR 7.55 (3.26-18.49), p < 0.001, EATv OR 1.02 (1.01-1.03), p < 0.001), CAD presence (BAC OR 4.26 (1.39-13), p = 0.01; EATv OR 1.01 (1.0-1.03), p = 0.04). CONCLUSION BAC and EATv are independent predictors of CV risk and CAD, but don't independently associate with each other, the relationship confounded by shared cardiovascular risk factors. BAC doesn't appear to associate with adipose tissue density and its presence may be cumulative result of long-term exposure to CV risk factors.
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Affiliation(s)
- Vinay Goel
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Ella Spear
- Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - William Cameron
- Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Nushrat Sultana
- Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Jasmine Chan
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Sean Tan
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Mitwa Joshi
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Andrew Roberts
- Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Yeong Chee Cheen
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia; Victorian Heart Institute, Blackburn Rd, Clayton 3800, Melbourne, Victoria, Australia
| | - Hannah Youn
- Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia
| | - Damini Dey
- Cedar-Sinai Medical Center, 8700 Beverly Blvd #2900A, Los Angeles, CA 90048, USA
| | - Esther Davis
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia; Victorian Heart Institute, Blackburn Rd, Clayton 3800, Melbourne, Victoria, Australia
| | - Stephen Nicholls
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia; Victorian Heart Institute, Blackburn Rd, Clayton 3800, Melbourne, Victoria, Australia
| | - Adam Brown
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia; Victorian Heart Institute, Blackburn Rd, Clayton 3800, Melbourne, Victoria, Australia
| | - Nitesh Nerlekar
- Monash University, Wellington Rd, Clayton 3800, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash Health, 246 Clayton Rd, Clayton 3168, Melbourne, Victoria, Australia; Victorian Heart Institute, Blackburn Rd, Clayton 3800, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne 3004, Melbourne, Victoria, Australia.
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Hillock-Watling C, Gotlieb AI. The pathobiology of perivascular adipose tissue (PVAT), the fourth layer of the blood vessel wall. Cardiovasc Pathol 2022; 61:107459. [PMID: 35907442 DOI: 10.1016/j.carpath.2022.107459] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/24/2022] [Accepted: 07/21/2022] [Indexed: 12/21/2022] Open
Abstract
The perivascular adipose tissue (PVAT) is an adipose tissue depot which surrounds most human blood vessels. It is metabolically active and has both a protective and a pathogenic role in vascular biology and pathobiology. It regulates vascular homeostasis and promotes vascular dysfunction. The purpose of this review is to consider the origin, structure, function, and dysfunction of this unique adipose depot consisting of white (WAT), brown (BAT) and beige adipose tissue, to support the concept that PVAT may be considered the fourth layer of the normal arterial wall (tunica adiposa), in which dysfunction creates a microenvironment that regulates, in part, the initiation and growth of the fibro-inflammatory lipid atherosclerotic plaque. Experimental in-vivo and in-vitro studies and human investigations show that the adipocytes, extracellular matrix, nerve fibers and vasa vasorum found in PVAT form a functional adipose tissue unit adjacent to, but not anatomically separated from, the adventitia. PVAT maintains and regulates the structure and function of the normal arterial wall through autocrine and paracrine mechanisms, that include modulation of medial smooth muscle cell contractility and secretion of anti-inflammatory molecules. PVAT shows regional phenotypic heterogeneity which may be important in its effect on the wall of specific sections of the aorta and its muscular branches during perturbations and various injuries including obesity and diabetes. In atherosclerosis, a pan-vascular microenvironment is created that functionally links the intima-medial atherosclerotic plaque to the adventitia and PVAT beneath the plaque, highlighting the local impact of PVAT on atherogenesis. PVAT adipocytes have inflammatory effects which in response to injury show activation and phenotypic changes, some of which are considered to have direct and indirect effects on the intima and media during the initiation, growth, and development of complicated atherosclerotic plaques. Thus, it is important to maintain the integrity of the full vascular microenvironment so that design of experimental and human studies include investigation of PVAT. The era of discarding PVAT tissue in both experimental and human research and clinical vascular studies should end.
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Affiliation(s)
- Cassie Hillock-Watling
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Avrum I Gotlieb
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Kagota S, Futokoro R, McGuire JJ, Maruyama-Fumoto K, Shinozuka K. Modulation of Vasomotor Function by Perivascular Adipose Tissue of Renal Artery Depends on Severity of Arterial Dysfunction to Nitric Oxide and Severity of Metabolic Parameters. Biomolecules 2022; 12:biom12070870. [PMID: 35883426 PMCID: PMC9312868 DOI: 10.3390/biom12070870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
Perivascular adipose tissue (PVAT) enhances vascular relaxation of mesenteric arteries in SHRSP.Z-Leprfa/IzmDmcr rats (SPZF), a metabolic syndrome model. We investigated and compared the effects of PVAT on the renal artery in SPZF with those on SHR/NDmcr-cp rats (CP). Renal arteries with and without PVAT were isolated from 23-week-old SPZF and CP. The effects of PVAT on acetylcholine- and nitroprusside-induced relaxation were examined using bioassays with phenylephrine-contracted arterial rings. Acetylcholine-induced relaxations without PVAT in SPZF and CP were 0.7- and 0.5-times lower in females than in males, respectively. In the presence of PVAT, acetylcholine-induced relaxations increased 1.4- and 2-times in male and female CP, respectively, but did not differ in SPZF. Nitroprusside-induced relaxation with and without PVAT was 0.7-times lower in female than in male SPZF but did not differ in CP. Angiotensin-II type-1 receptor (AT1R)/AT1R-associated protein mRNA ratios were lower in CP than in the SPZF and negatively correlated with the difference in arterial relaxation with and without PVAT. The effects of renal artery PVAT differed between the SPZF and CP groups. Higher levels of enhanced AT1R activity in SPZF PVAT may drive these differences by impairing the vascular smooth muscle responses to nitric oxide.
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Affiliation(s)
- Satomi Kagota
- Department of Pharmacology, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women’s University, Nishinomiya 663 8179, Japan; (R.F.); (K.M.-F.); (K.S.)
- Institute for Bioscience, Mukogawa Women’s University, Nishinomiya 663 8179, Japan
- Correspondence: ; Tel.: +81-798-45-9944
| | - Risa Futokoro
- Department of Pharmacology, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women’s University, Nishinomiya 663 8179, Japan; (R.F.); (K.M.-F.); (K.S.)
| | - John J. McGuire
- Departments of Medical Biophysics, Physiology & Pharmacology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada;
| | - Kana Maruyama-Fumoto
- Department of Pharmacology, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women’s University, Nishinomiya 663 8179, Japan; (R.F.); (K.M.-F.); (K.S.)
| | - Kazumasa Shinozuka
- Department of Pharmacology, School of Pharmacy and Pharmaceutical Sciences, Mukogawa Women’s University, Nishinomiya 663 8179, Japan; (R.F.); (K.M.-F.); (K.S.)
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van Meijeren AR, Ties D, de Koning MSLY, van Dijk R, van Blokland IV, Lizana Veloz P, van Woerden G, Vliegenthart R, Pundziute G, Westenbrink DB, van der Harst P. Association of epicardial adipose tissue with different stages of coronary artery disease: A cross-sectional UK Biobank cardiovascular magnetic resonance imaging substudy. IJC HEART & VASCULATURE 2022; 40:101006. [PMID: 35372662 PMCID: PMC8971641 DOI: 10.1016/j.ijcha.2022.101006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
Abstract
Objective Increased epicardial adipose tissue (EAT) has been identified as a risk factor for the development of coronary artery disease (CAD). However, the exact role of EAT in the development of CAD is unclear. This study aims to compare EAT volumes between healthy controls and individuals with stable CAD and a history of myocardial infarction (MI). Furthermore, associations between clinical and biochemical parameters with EAT volumes are examined. Methods This retrospective cross-sectional study included 171 participants from the United Kingdom Biobank (56 healthy controls; 60 stable CAD; 55 post MI), whom were balanced for age, sex and body mass index (BMI). EAT volumes were quantified on end-diastolic cardiac magnetic resonance (CMR) imaging short-axis slices along the left and right ventricle and indexed for body surface area (iEAT) and iEAT volumes were compared between groups. Results iEAT volumes were comparable between control, CAD and MI cases (median [IQR]: 66.1[54.4-77.0] vs. 70.9[55.8-85.5] vs. 67.6[58.6-82.3] mL/m2, respectively (p > 0.005 for all). Increased HDL-cholesterol was associated with decreased iEAT volume (β = -14.8, CI = -24.6 to -4.97, p = 0.003) and suggestive associations (P-value < 0.05 and ≥ 0.005) were observed between iEAT and triglycerides (β = 3.26, CI = 0.42 to 6.09, p = 0.02), Apo-lipoprotein A (β = -16.3, CI = -30.3 to -2.24, p = 0.02) and LDL-cholesterol (β = 3.99, CI = -7.15 to -0.84, p = 0.01). Conclusions No significant differences in iEAT volumes were observed between patients with CAD, MI and healthy controls. Our results indicate the importance of correcting for confounding by CVD risk factors, including circulating lipid levels, when studying the relationship between EAT volume and CAD. Further mechanistic studies on causal pathways and the role of EAT composition are warranted.
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Affiliation(s)
- Anne Ruth van Meijeren
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Daan Ties
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Marie-Sophie L Y de Koning
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Randy van Dijk
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Irene V van Blokland
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | | | - Gijs van Woerden
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Gabija Pundziute
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Daan B Westenbrink
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, the Netherlands.,Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Karampetsou N, Alexopoulos L, Minia A, Pliaka V, Tsolakos N, Kontzoglou K, Perrea DN, Patapis P. Epicardial Adipose Tissue as an Independent Cardiometabolic Risk Factor for Coronary Artery Disease. Cureus 2022; 14:e25578. [PMID: 35784958 PMCID: PMC9248997 DOI: 10.7759/cureus.25578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 02/07/2023] Open
Abstract
During the last decades, visceral adiposity has been at the forefront of scientific research because of its complex role in the pathogenesis of cardiovascular diseases. Epicardial adipose tissue (EAT) is the visceral lipid compartment between the myocardium and the visceral pericardium. Due to their unobstructed anatomic vicinity, epicardial fat and myocardium are nourished by the same microcirculation. It is widely known that EAT serves as an energy lipid source and thermoregulator for the human heart. In addition to this, epicardial fat exerts highly protective effects since it releases a great variety of anti-inflammatory molecules to the adjacent cardiac muscle. Taking into account the unique properties of human EAT, it is undoubtedly a key factor in cardiac physiology since it facilitates complex heart functions. Under pathological circumstances, however, epicardial fat promotes coronary atherosclerosis in a variety of ways. Therefore, the accurate estimation of epicardial fat thickness and volume could be utilized as an early detecting method and future medication target for coronary artery disease (CAD) elimination. Throughout the years, several therapeutic approaches for dysfunctional human EAT have been proposed. A balanced healthy diet, aerobic and anaerobic physical activity, bariatric surgery, and pharmacological treatment with either traditional or novel antidiabetic and antilipidemic drugs are some of the established medical approaches. In the present article, we review the current knowledge regarding the anatomic and physiological characteristics of epicardial fat. In addition to this, we describe the pathogenic mechanisms which refer to the crosstalk between epicardial fat alteration and coronary arterial atherosclerosis development. Lastly, we present both lifestyle and pharmacological methods as possible treatment options for EAT dysfunction.
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Nerlekar N, Chan J. Pericoronary Adipose Tissue: Another Arrow in the Quiver of CT Coronary Angiography. JACC Cardiovasc Imaging 2022; 15:840-842. [PMID: 35033491 DOI: 10.1016/j.jcmg.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University, Monash Heart, Monash Health, Clayton, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Jasmine Chan
- Monash Cardiovascular Research Centre, Monash University, Monash Heart, Monash Health, Clayton, Victoria, Australia
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Kagota S, Futokoro R, Maruyama-Fumoto K, McGuire JJ, Shinozuka K. Perivascular Adipose Tissue Compensation for Endothelial Dysfunction in the Superior Mesenteric Artery of Female SHRSP.Z-<i>Lepr</i><sup><i>fa</i></sup>/IzmDmcr Rats. J Vasc Res 2022; 59:209-220. [DOI: 10.1159/000524187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/14/2022] [Indexed: 12/17/2022] Open
Abstract
Regulation of arterial tone by perivascular adipose tissue (PVAT) differs between sexes. In male SHRSP.Z-<i>Lepr</i><sup><i>fa</i></sup>/IzmDmcr rats (SHRSP.ZF), PVAT exerts a compensatory relaxation effect for the loss of endothelium-mediated vasorelaxation, which occurs during the early stages of metabolic syndrome. However, this effect deteriorates by 23 weeks of age. Here, therefore, we compared the effects of PVAT in female and male SHRSP.ZF. Acetylcholine-induced relaxation in superior mesenteric artery without PVAT did not differ between 23-week-old females and males. However, the presence of PVAT enhanced relaxation in 23-week-old females, but not in males. The mRNA levels of angiotensin II type 1 receptor (AT1R) in PVAT did not differ between sexes, but AT1R-associated protein (ATRAP) and apelin levels were higher in females than in males. We observed a positive relationship between differences in artery relaxation with and without PVAT and ATRAP or apelin mRNA levels. In 30-week-old females, PVAT-enhanced relaxation disappeared, and mRNA levels of AT1R increased, while apelin levels decreased compared to 23-week-old females. These results demonstrated that in SHRSP.ZF, PVAT compensation for endothelium dysfunction extended to older ages in females than in males. Apelin and AT1R/ATRAP expression in PVAT may be predictors of favorable effects.
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Kagiyama N, Tokodi M, Sengupta PP. Machine Learning in Cardiovascular Imaging. Heart Fail Clin 2022; 18:245-258. [DOI: 10.1016/j.hfc.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Greco F, Salgado R, Van Hecke W, Del Buono R, Parizel PM, Mallio CA. Epicardial and pericardial fat analysis on CT images and artificial intelligence: a literature review. Quant Imaging Med Surg 2022; 12:2075-2089. [PMID: 35284252 PMCID: PMC8899943 DOI: 10.21037/qims-21-945] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/03/2021] [Indexed: 07/24/2023]
Abstract
The present review summarizes the available evidence on artificial intelligence (AI) algorithms aimed to the segmentation of epicardial and pericardial adipose tissues on computed tomography (CT) images. Body composition imaging is a novel concept based on quantitative analysis of body tissues. Manual segmentation of medical images allows to obtain quantitative and qualitative data on several tissues including epicardial and pericardial fat. However, since manual segmentation requires a considerable amount of time, the analysis of adipose tissue compartments based on AI has been proposed as an automatic, reliable, accurate and fast tool. The literature research was performed on March 2021 using MEDLINE PubMed Central and "adipose tissue artificial intelligence", "adipose tissue deep learning" or "adipose tissue machine learning" as keywords for articles search. Relevant articles concerning epicardial adipose tissue, pericardial adipose tissue and AI were selected. The evaluation of adipose tissue compartments can provide additional information on the pathogenesis and prognosis of several diseases, including cardiovascular. AI can assist physicians to obtain important information, possibly improving the patient's quality of life and identifying patients at risk of developing variable disorders.
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Affiliation(s)
- Federico Greco
- U.O.C. Diagnostica per Immagini Territoriale Aziendale, Cittadella della Salute Azienda Sanitaria Locale di Lecce, Lecce, Italy
| | - Rodrigo Salgado
- Department of Radiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Wim Van Hecke
- AI Supported Modelling in Clinical Sciences (AIMS), Vrije Universiteit Brussel, 1050 Brussels, Belgium and founder of icoMetrix, Leuven, Belgium
| | - Romualdo Del Buono
- Unit of Anesthesia, Resuscitation, Intensive Care and Pain Management, ASST Gaetano Pini, Milano, Italy
| | - Paul M. Parizel
- Royal Perth Hospital & University of Western Australia, Perth, Western Australia, Australia
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Wan Q, Ding T, Xu Y, Zheng C, Tu M, Zhao T. Urban fine particulate air pollution exposure promotes atherosclerosis in apolipoprotein E-deficient mice by activating perivascular adipose tissue inflammation via the Wnt5a/Ror2 signaling pathway. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 227:112912. [PMID: 34673409 DOI: 10.1016/j.ecoenv.2021.112912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
Urban fine particulate matter (PM2.5) is a deleterious risk factor in the ambient air and is recognized to exacerbate atherosclerosis. Perivascular adipose tissue (PVAT) secretes a large number of inflammatory cytokines and plays a crucial role in the pathogenic microenvironment of atherogenesis. However, there is a lack of knowledge about the role of PVAT inflammation in the genesis of PM2.5-related atherosclerosis. The aim of this research was to probe the latent links between PM2.5 exposure and PVAT inflammation and further discovered the underlying mechanisms of PM2.5-triggered atherosclerosis pathogenesis. Apolipoprotein E-deficient (ApoE-/-) mice were exposed to real-world atmospheric PM2.5 or filtered clean air for three months, the Wnt5a inhibitor Box5 and the Ror2 inhibitor β-Arrestin2 were applied to verify the possible mechanisms. We noticed that the average daily PM2.5 mass concentration was 84.27 ± 28.84 μg/m3. PM2.5 inhalation might significantly expedite the deterioration of atherosclerosis, increase the protein and mRNA expressions of MCP-1, IL-6, TNF-α, Wnt5a, and Ror2 in PVAT tissues, upregulate the distributions of IL-6, TNF-α, MCP-1, and leptin in the histological sections of PVAT, promote lipid deposition in the aorta, elevate the plasma levels of leptin, MCP-1, IL-6, TNF-α, LDL-C, TC, and TG, however, decrease the plasma levels of adiponectin and HDL-C, downregulate the distribution of adiponectin. Nevertheless, these effects caused by PM2.5 exposure were dramatically diminished after the administration of Box5 or β-Arrestin2. This research illuminated that PVAT inflammation was involved in the PM2.5-induced atherosclerosis process, as well as lipid deposition, which was closely associated with the activation of the Wnt5a/Ror2 signaling pathway.
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Affiliation(s)
- Qiang Wan
- The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang 330006, China; Clinical Medical College, Jiangxi University of Chinese Medicine, Nanchang 330006, China.
| | - Tao Ding
- Graduate School, Jiangxi University of Chinese Medicine, Nanchang 330004, China
| | - Yulin Xu
- Graduate School, Jiangxi University of Chinese Medicine, Nanchang 330004, China
| | - Cuicui Zheng
- Graduate School, Jiangxi University of Chinese Medicine, Nanchang 330004, China
| | - Mengting Tu
- Graduate School, Jiangxi University of Chinese Medicine, Nanchang 330004, China
| | - Tong Zhao
- Graduate School, Jiangxi University of Chinese Medicine, Nanchang 330004, China
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Liu Y, Xu L, Gu Y, Zhang Y, Miao C. Impact of H-Type Hypertension on Pericarotid Adipose Tissue and Plaque Characteristics Based on Computed Tomography (CT) Angiography: A Propensity Score Matching Study. Med Sci Monit 2021; 27:e933351. [PMID: 34857728 PMCID: PMC8650409 DOI: 10.12659/msm.933351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We analyzed the correlation among the inflammatory changes in pericarotid adipose tissue (PCAT), plaque characteristics, and H-type hypertension on CT angiography (CTA) and explored the utility of CTA in the prevention and treatment of carotid atherosclerosis. MATERIAL AND METHODS A total of 135 patients who underwent head and neck CTA to investigate carotid artery atherosclerosis were retrospectively analyzed. The plaque characteristic parameters (plaque burden and remodeling index), PCAT attenuation value, and net enhancement value around the carotid artery, where the plaques were located, were recorded, and confounding factors were matched by propensity score analysis. A paired t test was used to compare the differences in fat tissue inflammatory changes and plaque characteristic parameters between the 2 groups, and logistic regression analysis was used to evaluate the relationship between plaque characteristics and the attenuation values and net enhancement values of PCAT. The correlation coefficient was calculated between type H hypertension and plaque risk grade. RESULTS The results of the experiment indicate that PCAT attenuation values and net enhancement values gradually increased as the degree of hypertension increased. Compared with those of patients in the normal Hcy group, these values increased more clearly in patients with high Hcy (HHcy) (r=0.641, P<0.001, r=0.581, P<0.001), although, regardless of whether the Hcy value increased, there were significant differences between the groups. However, this effect was more pronounced in patients with H-type hypertension. Logistic regression analysis of risk factors for carotid atherosclerotic plaque suggests that Hcy (OR=1.391, 95% CI 1.146-1.689, P=0.001), PCAT attenuation values (OR=1.212, 95% CI 1.074-1.367, P=0.002), and net enhancement values (OR=1.201, 95% CI 1.042-1.383, P=0.011) were independent risk factors for plaque vulnerability. CONCLUSIONS Our results suggest that H-type hypertension is significantly associated with PCAT attenuation and net enhancement and that PCAT net enhancement values are useful in predicting plaque risk as attenuation.
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Affiliation(s)
- Ying Liu
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, China (mainland)
| | - Lun Xu
- Department of Neurosurgery, Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang, Jiangsu, China (mainland)
| | - Yan Gu
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, China (mainland)
| | - Yonggang Zhang
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, China (mainland)
| | - Chongchang Miao
- Department of Radiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, China (mainland)
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Lin A, Kolossváry M, Motwani M, Išgum I, Maurovich-Horvat P, Slomka PJ, Dey D. Artificial intelligence in cardiovascular CT: Current status and future implications. J Cardiovasc Comput Tomogr 2021; 15:462-469. [PMID: 33812855 PMCID: PMC8455701 DOI: 10.1016/j.jcct.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/29/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022]
Abstract
Artificial intelligence (AI) refers to the use of computational techniques to mimic human thought processes and learning capacity. The past decade has seen a rapid proliferation of AI developments for cardiovascular computed tomography (CT). These algorithms aim to increase efficiency, objectivity, and performance in clinical tasks such as image quality improvement, structure segmentation, quantitative measurements, and outcome prediction. By doing so, AI has the potential to streamline clinical workflow, increase interpretative speed and accuracy, and inform subsequent clinical pathways. This review covers state-of-the-art AI techniques in cardiovascular CT and the future role of AI as a clinical support tool.
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Affiliation(s)
- Andrew Lin
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Márton Kolossváry
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Manish Motwani
- Manchester Heart Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Ivana Išgum
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Piotr J Slomka
- Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Dang Y, Chen X, Ma S, Ma Y, Ma Q, Zhou K, Liu T, Wang K, Hou Y. Association of Pericoronary Adipose Tissue Quality Determined by Dual-Layer Spectral Detector CT With Severity of Coronary Artery Disease: A Preliminary Study. Front Cardiovasc Med 2021; 8:720127. [PMID: 34660721 PMCID: PMC8514719 DOI: 10.3389/fcvm.2021.720127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pericoronary adipose tissue (PCAT) is considered as a source of inflammatory mediators, leading to the development of coronary atherosclerosis. The study aimed to investigate the correlation between PCAT quality derived from dual-layer spectral detector CT (SDCT) and the severity of coronary artery disease (CAD), and whether PCAT parameters were independently associated with the presence of CAD. Materials and Methods: A total of 403 patients with symptoms of chest pain who underwent SDCT were included. PCAT quality including fat attenuation index (FAI) measured from conventional polychromatic CT images (FAI120kvp) and spectral virtual mono-energetic images at 40 keV (FAI40keV), slope of spectral HU curve (λHU), and effective atomic number (Eff-Z) were measured around the lesions representing the maximal degree of vascular stenosis in each patient. Meanwhile, overall epicardial adipose tissue (EAT) attenuation was acquired in the conventional polychromatic energy imaging. Results: FAI40keV, λHU, Eff-Z, and FAI120kvp increased along with the degree of CAD in general and were superior to the overall EAT attenuation for detecting the presence of CAD. Multivariate logistic regression analysis indicated that FAI40keV was the most powerful independent indicator (odds ratio 1.058, 95% CI 1.044–1.073; p < 0.001) of CAD among these parameters. Using an optimal cut-off (−131.8 HU), FAI40keV showed higher diagnostic accuracy of 80.6% compared with the other parameters. Conclusions: These preliminary findings suggest that FAI40keV on SDCT may be an appealing surrogate maker to allow monitoring of PCAT changes in the development of CAD.
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Affiliation(s)
- Yuxue Dang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xujiao Chen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shaowei Ma
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Quanmei Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ke Zhou
- Department of Cardiac Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ting Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Kunhua Wang
- Department of Radiology, The People's Hospital of Liaoning Province, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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Gao Z, Zuo Y, Jia L, Yin Y, Yang X, Fan Y, Liu H. Association between epicardial adipose tissue density and characteristics of coronary plaques assessed by coronary computed tomographic angiography. Int J Cardiovasc Imaging 2021; 38:673-681. [PMID: 34652589 DOI: 10.1007/s10554-021-02428-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/23/2021] [Indexed: 12/20/2022]
Abstract
To investigate the relationship between the epicardial adipose tissue density (EATD) and the coronary plaque components as assessed by coronary computed tomographic angiography (CCTA). The study cohort included 240 patients with chest pain or precardiac discomfort (mean age 62.01 ± 7.45 years, 55.83% male). Patients were assigned to the high-risk plaque (HRP) group (n = 133) or non-HRP group (n = 107). All patients underwent CCTA to assess plaque composition, and quantitative analysis of EATD and epicardial adipose tissue volume (EATV). Age, gender, EATV, EATD, diabetes history and family history were all correlated with HRP. There was no linear correlation between EATD and EATV among the subjects (R2 = 0.008, p = 0.177), but there was a curvilinear correlation (R2 = 0.102, p < 0.001). After adjusting other traditional factors, and we observed robust associations of EAT volume and density with HRP (all p < 0.05). For per 1 standard deviation increase in EATD, the risk of HRP was 3.120 times the risk than that of non-HRP. For per 1 standard deviation increase in EATV, the risk of HRP was 1.499 times the risk than that of non-HRP. The receiver operating characteristic curve showed that EATD was more predictive of HRP than EATV (AUC = 0.761, 95% CI 0.701-0.822). Our study found that EATD and EATV are both independent factors affecting the presence of HRPs, and EATD had a high predictive value for the presence of HRP.
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Affiliation(s)
- Zhihong Gao
- Department of Physical Examination Center, The Second Hospital of Hebei Medical University, Shijiazhuang, 050005, Hebei, People's Republic of China
| | - Yuqiang Zuo
- Department of Physical Examination Center, The Second Hospital of Hebei Medical University, Shijiazhuang, 050005, Hebei, People's Republic of China
| | - Linyi Jia
- Department of Imaging, Xingtai People's Hospital, Xingtai, 054001, Hebei, People's Republic of China
| | - Yuling Yin
- Department of Physical Examination Center, The Second Hospital of Hebei Medical University, Shijiazhuang, 050005, Hebei, People's Republic of China
| | - Xu Yang
- Department of Physical Examination Center, The Second Hospital of Hebei Medical University, Shijiazhuang, 050005, Hebei, People's Republic of China
| | - Yimeng Fan
- Department of Imaging Center, Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Huaijun Liu
- Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050005, Hebei, People's Republic of China.
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Assessment of Coronary Inflammation by Pericoronary Fat Attenuation Index in Clinically Suspected Myocarditis with Infarct-Like Presentation. J Clin Med 2021; 10:jcm10184200. [PMID: 34575310 PMCID: PMC8465666 DOI: 10.3390/jcm10184200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/19/2022] Open
Abstract
Background: The pathophysiology of angina-like symptoms in myocarditis is still unclear. Perivascular fat attenuation index (pFAI) by coronary computed tomography angiography (CCTA) is a non-invasive marker of coronary inflammation (CI) in atherosclerosis. We explored the presence of CI in clinically suspected myocarditis with infarct-like presentation. Methods: We retrospectively included 15 consecutive patients (67% male, age 30 ± 10 years) with clinically suspected infarct-like myocarditis who underwent CCTA to rule out coronary artery disease. Right coronary artery (RCA) pFAI mean value was compared with that of healthy volunteers. Results: Mean RCA pFAI value was −92.8 ± 8.4 HU, similar to that of healthy volunteers (−95.2 ± 6.0, p = 0.8). We found no correlation between RCA pFAI mean values and peak Troponin I (r = −0.43, p = 0.11) and C-reactive protein at diagnosis (r = −0.25, p = 0.42). Patients with higher pFAI values showed higher biventricular end-systolic volumes (ESV) (p = 0.038 for left and p = 0.024 for right ventricle) and lower right ventricular ejection fraction (RVEF) (p = 0.038) on cardiovascular magnetic resonance. Conclusions: In clinically suspected myocarditis with infarct-like presentation, RCA pFAI values are lower than those validated in atherosclerosis. The correlation between higher pFAI values, higher biventricular ESV and lower RVEF, may suggest a role of pFAI in predicting non-atherosclerotic CI (i.e., infective/immune-mediated “endothelialitis”).
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