Stress-Related Neural Activity Associates With Coronary Plaque Vulnerability and Subsequent Cardiovascular Events.

Area of Science:

• Cardiology
• Neuroscience
• Radiology

Background:

• Stress-related neural activity (SNA), assessed via amygdalar activity, is a known predictor of cardiovascular events.
• The precise mechanisms linking SNA to coronary plaque vulnerability remain incompletely understood.

Purpose of the Study:

• To investigate the association between SNA and coronary plaque morphology and inflammation.
• To evaluate the predictive capability of SNA for major adverse cardiovascular events (MACE).

Main Methods:

• Utilized 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and coronary computed tomographic angiography (CCTA) in 299 coronary artery disease patients.
• Assessed SNA, bone marrow activity (BMA), coronary inflammation (fat attenuation index [FAI]), and high-risk plaque (HRP) characteristics.
• Employed Cox models, log-rank tests, and mediation analyses to examine relationships and MACE prediction.

Main Results:

• SNA significantly correlated with BMA (r=0.39) and FAI (r=0.49).
• Patients with heightened SNA were more likely to exhibit HRP (40.7% vs 23.5%) and had an increased risk of MACE (adjusted HR 3.22).
• Mediation analysis revealed SNA associates with MACE through BMA, FAI, and HRP.

Conclusions:

• SNA is significantly correlated with coronary inflammation (FAI) and high-risk plaque (HRP) in patients with coronary artery disease.
• SNA is associated with MACE, with a mediating role played by bone marrow activity, coronary inflammation, and plaque vulnerability.