Determinants of Pericoronary Adipose Tissue Attenuation on Computed Tomography Angiography in Coronary Artery Disease

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Tomoyo Sugiyama1, Yoshihisa Kanaji1, Masahiro Hoshino1

  • 1Department of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Tsuchiura Ibaraki Japan.

Journal of the American Heart Association
|August 5, 2020
PubMed

Insights

Pericoronary adipose tissue attenuation (PCATA) on CT angiography indicates inflammation and predicts worse outcomes in coronary artery disease. Key determinants of increased PCATA include male sex, left ventricular mass, and significant coronary stenosis.

Area of Science:

  • Cardiovascular Imaging
  • Radiology
  • Inflammation Markers

Background:

  • Recent studies link pericoronary adipose tissue attenuation (PCATA) on computed tomography angiography (CTA) to adverse outcomes in coronary artery disease (CAD).
  • PCATA quantifies pericoronary inflammation, a potential marker of cardiovascular risk.
  • Understanding the predictors of increased PCATA is crucial for risk stratification in patients with CAD.

Purpose of the Study:

  • To identify the clinical and imaging determinants of increased pericoronary adipose tissue attenuation (PCATA).
  • To investigate predictors of PCATA in patients undergoing computed tomography angiography (CTA) and invasive coronary angiography (ICA).
  • To explore sex-specific determinants of PCATA in the context of coronary artery disease.

Main Methods:

  • A total of 540 patients with known or suspected coronary artery disease underwent CTA and ICA.
  • Pericoronary adipose tissue attenuation (PCATA) was measured in the proximal 40-mm segments of the three major coronary arteries.
  • Univariable and multivariable linear regression analyses were performed to identify independent predictors of PCATA, including sex, left ventricular mass index, and coronary stenosis.

Main Results:

  • Independent determinants of right coronary artery-PCATA included male sex (β=4.965, P<0.001), left ventricular mass index (β=0.040, P=0.025), and significant coronary stenosis (β=2.418, P=0.008).
  • Sex-specific analyses revealed different predictors: male patients showed associations with NT-proBNP, Agatston score, LVMI, and stenosis; female patients with LVEF and stenosis.
  • The average PCATA across three vessels was -70.24±6.60 Hounsfield units, with significant associations with clinical factors and epicardial stenosis.

Conclusions:

  • Pericoronary adipose tissue attenuation (PCATA) is associated with multiple clinical characteristics, cardiovascular risk factors, and the presence of significant coronary artery stenosis.
  • Factors such as sex, left ventricular hypertrophy, ejection fraction, coronary calcification (Agatston score), and epicardial stenosis are important considerations when assessing pericoronary inflammation via CTA.
  • These findings highlight the clinical significance of PCATA as a marker of inflammation in coronary artery disease, influenced by a combination of patient demographics and disease severity.

Keywords:
adipose tissuecomputed tomography angiographycoronary artery diseaseinflammation

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