CARDIOVASCULAR RADIOLOGY / ORIGINAL PAPER
Determinants of perivascular adipose tissue stranding as a novel imaging marker and its relation to inflammatory biomarker high-sensitivity C-reactive protein
More details
Hide details
1
Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
2
Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
3
Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Centre (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
4
Department of Radiology, Modarres Hospital Shahid Beheshti University of Medical Sciences, Tehran, Iran
5
Cardiovascular Intervention Research Centre, Cardio-Oncology Research Centre, Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
6
Cardiovascular Intervention Research Centre, Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
7
Cardiogenetic Research Centre, Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
Submission date: 2022-10-11
Final revision date: 2022-11-26
Acceptance date: 2022-12-12
Publication date: 2023-03-18
Pol J Radiol, 2023; 88: 141-148
KEYWORDS
TOPICS
ABSTRACT
Introduction:
This study aimed to examine the relationship of perivascular adipose tissue (PVAT) stranding in coronary computed tomography angiography (CCTA) with high-sensitivity C-reactive protein (hsCRP) and the determinants of PVAT stranding in coronary artery disease (CAD) patients.
Material and methods:
This retrospective cross-sectional study was done by collecting data from CAD patients who were referred to Rajaie Cardiovascular Centre between January 2018 and September 2020, with CCTA and hsCRP test 72 hours apart from the CCTA. PVAT stranding was defined as irregular obscuration of PVAT adjacent to the coronary arteries. An attempt was made to find a correlation between included variables and PVAT stranding by comparing them between 2 groups: patients with and without PVAT stranding.
Results:
From 92 patients, 31 participants had PVAT stranding, and statistically significant higher levels of hsCRP were detected in them (p = 0.007). We demonstrated significantly higher prevalence of history of hyperlipidaemia (OR = 3.83, p = 0.029), high-risk plaque features (OR = 11.80, p = 0.015), and obstructive coronary luminal stenosis (OR = 3.25, p = 0.025) in patients with PVAT stranding. Also, significantly higher PVAT attenuation was detected in patients with PVAT stranding (p < 0.001) independently from mean attenuation of epicardial fat.
Conclusions:
PVAT stranding could be used as a novel non-invasive marker in CCTA of CAD patients. More studies focusing on patient outcomes are required to better evaluate the reliability and prognostic value of this marker.
REFERENCES (27)
1.
Khan MA, Hashim MJ, Mustafa H, et al. Global epidemiology of ischemic heart disease: results from the Global Burden of Disease Study. Cureus 2020; 12: e9349. doi: 10.7759/cureus.9349.
2.
Kalbacher D, Waldeyer C, Blankenberg S, et al. Beyond conventional secondary prevention in coronary artery disease-what to choose in the era of CANTOS, COMPASS, FOURIER, ODYSSEY and PEGASUS-TIMI 54? A review on contemporary literature. Ann Transl Med 2018; 6: 323. doi: 10.21037/atm.2018.08.03.
3.
Antoniades C, Kotanidis CP, Berman DS. State-of-the-art review article. Atherosclerosis affecting fat: what can we learn by imaging perivascular adipose tissue? J Cardiovasc Comput Tomogr 2019; 13: 288-296.
4.
Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med 1999; 340: 115-126.
5.
Antonopoulos AS, Margaritis M, Lee R, et al. Statins as anti-inflammatory agents in atherogenesis: molecular mechanisms and lessons from the recent clinical trials. Curr Pharm Des 2012; 18: 1519-1530.
6.
Ridker PM. C-reactive protein and the prediction of cardiovascular events among those at intermediate risk: moving an inflammatory hypothesis toward consensus. J Am Coll Cardiol 2007; 49: 2129-2138.
7.
Margaritis M, Antonopoulos AS, Digby J, et al. Interactions between vascular wall and perivascular adipose tissue reveal novel roles for adiponectin in the regulation of endothelial nitric oxide synthase function in human vessels. Circulation 2013; 127: 2209-2221.
8.
Wykrzykowska J, Lehman S, Williams G, et al. Imaging of inflamed and vulnerable plaque in coronary arteries with 18F-FDG PET/CT in patients with suppression of myocardial uptake using a low-carbohydrate, high-fat preparation. J Nucl Med 2009; 50: 563-568.
9.
Antonopoulos AS, Sanna F, Sabharwal N, et al. Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med 2017; 9: eaal2658. doi: 10.1126/scitranslmed.aal2658.
10.
Chen X, Dang Y, Hu H, et al. Pericoronary adipose tissue attenuation assessed by dual-layer spectral detector computed tomography is a sensitive imaging marker of high-risk plaques. Quant Imaging Med Surg 2021; 11: 2093-2103.
11.
Yuvaraj J, Lin A, Nerlekar N, et al. Pericoronary adipose tissue attenuation is associated with high-risk plaque and subsequent acute coronary syndrome in patients with stable coronary artery disease. Cells 2021; 10: 1143. doi: 10.3390/cells10051143.
12.
Goeller M, Tamarappoo BK, Kwan AC, et al. Relationship between changes in pericoronary adipose tissue attenuation and coronary plaque burden quantified from coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2019; 20: 636-643.
13.
Goeller M, Achenbach S, Cadet S, et al. Pericoronary adipose tissue computed tomography attenuation and high-risk plaque characteristics in acute coronary syndrome compared with stable coronary artery disease. JAMA Cardiol 2018; 3: 858-863.
14.
Hedgire S, Baliyan V, Zucker EJ, et al. Perivascular epicardial fat stranding at coronary CT angiography: a marker of acute plaque rupture and spontaneous coronary artery dissection. Radiology 2018; 287: 808-815.
15.
Oikonomou EK, Williams MC, Kotanidis CP, et al. A novel machine learning-derived radiotranscriptomic signature of perivascular fat improves cardiac risk prediction using coronary CT angiography. Eur Heart J 2019; 40: 3529-3543.
16.
Klüner LV, Oikonomou EK, Antoniades C. Assessing cardiovascular risk by using the fat attenuation index in coronary CT angiography. Radiol Cardiothorac Imaging 2021; 3: e200563. doi: 10.1148/ryct.2021200563.
17.
Oikonomou EK, Marwan M, Desai MY, et al. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. Lancet 2018; 392: 929-939.
18.
Raggi P, Gadiyaram V, Zhang C, et al. Statins reduce epicardial adipose tissue attenuation independent of lipid lowering: a potential pleiotropic effect. J Am Heart Assoc 2019; 8: e013104. doi: 10.1161/JAHA.119.013104.
19.
Puchner SB, Liu T, Mayrhofer T, et al. High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial. J Am Coll Cardiol 2014; 64: 684-692.
20.
Cury RC, Abbara S, Achenbach S, et al. CAD-RADS™: Coronary Artery Disease – Reporting and Data System: an expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. J Am Coll Radiol 2016; 13 (12 Pt A): 1458-1466.e9. doi: 10.1016/j.jacr.2016.04.024.
21.
Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827-832.
22.
Dai X, Deng J, Yu M, et al. Perivascular fat attenuation index and high-risk plaque features evaluated by coronary CT angiography: relationship with serum inflammatory marker level. Int J Cardiovasc Imaging 2020; 36: 723-730.
23.
Sugiyama T, Kanaji Y, Hoshino M, et al. Determinants of pericoronary adipose tissue attenuation on computed tomography angiography in coronary artery disease. J Am Heart Assoc 2020; 9: e016202. doi: 10.1161/JAHA.120.016202.
24.
Tajfard M, Tavakoly Sany SB, Avan A, et al. Relationship between serum high sensitivity C-reactive protein with angiographic severity of coronary artery disease and traditional cardiovascular risk factors. J Cell Physiol 2019; 234: 10289-10299.
25.
Seyedian SM, Ahmadi F, Dabagh R, et al. Relationship between high-sensitivity C-reactive protein serum levels and the severity of coronary artery stenosis in patients with coronary artery disease. ARYA Atheroscler 2016; 12: 231-237.
26.
Sun JT, Sheng XC, Feng Q, et al. Pericoronary fat attenuation index is associated with vulnerable plaque components and local immune-inflammatory activation in patients with non-ST elevation acute coronary syndrome. J Am Heart Assoc 2022; 11: e022879. doi: 10.1161/JAHA.121.022879.
27.
Almeida S, Pelter M, Shaikh K, et al. Feasibility of measuring pericoronary fat from precontrast scans: Effect of iodinated contrast on pericoronary fat attenuation. J Cardiovasc Comput Tomogr 2020; 14: 490-494.