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Human coronary inflammation by computed tomography: Relationship with coronary microvascular dysfunction.

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|May 30, 2021
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Coronary inflammation, measured by peri-coronary adipose tissue (PCAT) CT attenuation, is independently linked to coronary microvascular function (CFVR-lad) in individuals without severe coronary artery disease (CAD). This finding highlights a connection between inflammation and blood flow in the heart.

Keywords:
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Area of Science:

  • Cardiovascular Imaging
  • Cardiac Physiology
  • Coronary Artery Disease Research

Background:

  • Coronary computed tomography angiography (CCTA) offers a validated metric (peri-coronary adipose tissue (PCAT) CT attenuation) to assess coronary inflammation.
  • The impact of coronary inflammation on microvascular function, evaluated non-invasively via coronary flow velocity reserve in the left anterior descending artery (CFVR-lad) using stress-echocardiography (SE), remains unclear.
  • A hypothesis posits that coronary inflammation influences CFVR-lad, particularly in the absence of obstructive coronary artery disease (CAD).

Purpose of the Study:

  • To investigate the relationship between coronary inflammation (PCAT CT attenuation) and coronary microvascular function (CFVR-lad).
  • To assess this relationship in subjects with no or non-obstructive coronary artery disease (CAD).

Main Methods:

  • Evaluation of 202 subjects with no or non-obstructive (<70% diameter stenosis) coronary artery disease (CAD).
  • Measurement of coronary inflammation using peri-coronary adipose tissue (PCAT) CT attenuation from coronary computed tomography angiography (CCTA).
  • Assessment of coronary microvascular function via Doppler measurement of coronary flow velocity reserve in the left anterior descending artery (CFVR-lad) during stress-echocardiography (SE).

Main Results:

  • A significant inverse relationship was observed between PCAT CT attenuation and CFVR-lad across all enrolled subjects (r = -0.32, p < 0.001).
  • The correlation was significant in subjects with no CAD (r = -0.40, R² = -0.16, p < 0.001) and mild CAD-lad (r = -0.35, R² = -0.12, p = 0.001).
  • No significant correlation was found in subjects with intermediate CAD-lad.

Conclusions:

  • Coronary microvascular function, assessed by CFVR-lad during SE, is independently related to local coronary inflammation (PCAT attenuation) in individuals without severely obstructive CAD in the left anterior descending artery.
  • This finding establishes a link between coronary inflammation and microvascular dysfunction even in the early stages of coronary artery disease.