Pericoronary adipose tissue attenuation in patients with acute aortic dissection based on coronary computed
Yong-Bo Tu1, Min Gu1, Shao-Quan Zhou1
1Department of Radiology, Chongqing General Hospital, Chongqing, China.
Insights
Inflammation in acute aortic dissection (AAD) increases pericoronary adipose tissue attenuation (PCATa). This imaging marker indicates vascular inflammation independent of coronary artery disease, suggesting potential for AAD prediction and monitoring.
Area of Science:
- Cardiovascular Imaging
- Thoracic Surgery
- Radiology
Background:
- Periaortic fat inflammation is linked to coronary artery disease.
- Acute aortic dissection (AAD) may cause inflammation to spread to pericoronary adipose tissue (PCAT).
- Pericoronary adipose tissue attenuation (PCATa) quantifies inflammation in perivascular adipose tissue (PVAT).
Purpose of the Study:
- To investigate PCATa in patients diagnosed with AAD.
- To determine if AAD is associated with increased PCATa.
- To explore the relationship between PCATa and coronary artery disease in AAD patients.
Main Methods:
- Prospective enrollment of patients with chest pain undergoing computed tomography angiography (CTA).
- Classification of patients into AAD and non-AAD groups based on CTA results.
- Quantification of PCATa for the right coronary artery (RCA), left anterior descending (LAD), and left circumflex (LCx) arteries using semi-automated software.
Main Results:
- PCATa values were significantly higher in the AAD group compared to the non-AAD group for RCA, LAD, and LCx, irrespective of coronary artery disease presence.
- Preoperative PCATa values in AAD patients were higher than in the postoperative steady state.
- Multivariable logistic regression identified high RCAPCATa and LADPCATa as independent predictors of AAD.
Conclusions:
- Elevated PCATa observed in AAD patients suggests systemic vascular inflammation independent of coronary artery disease.
- PCATa may serve as a valuable imaging biomarker for AAD.
- Further research is warranted to explore PCATa's role in predicting AAD and monitoring treatment response.
Background:
Periaortic fat is associated with coronary disease. Thus, it was hypothesized that the inflammation associated with acute aortic dissection (AAD) spreads to pericoronary adipose tissue (PCAT) via thoracic periaortic fat. Pericoronary adipose tissue attenuation (PCATa) serves as a marker for inflammation of perivascular adipose tissue (PVAT). This study sought to examine PCATa in individuals diagnosed with AAD.
Methods:
Consecutive patients with chest pain from May 2020 to September 2022 were prospectively enrolled in this study and underwent coronary computed tomography angiography (CCTA) and/or aorta computed tomography angiography (CTA). Based on the results of the CTA, the patients were divided into the following two groups: (I) the AAD group; and (II) the non-AAD group. PCATa of the right coronary angiography (RCA), left anterior descending (LAD), and left circumflex (LCx) was quantified for each patient using semi-automated software. The PCATa values were compared between the AAD and non-AAD patients according to the atherosclerosis of the coronary arteries. Similarly, the PCATa values of the AAD patients were compared between the preoperative and postoperative steady states.
Results:
A total of 136 patients (42 female, 94 male; mean age: 63.3±11.9 years) were divided into the two groups according to the presence of aortic dissection on CTA. The RCAPCATa, LADPCATa, and LCxPCATa values were significantly higher in the AAD subjects than the non-AAD subjects, regardless of the presence or absence of atherosclerosis in the coronary arteries [-85.1±9.3 vs. -92.9±10.0 Hounsfield unit (HU); -83.2±7.4 vs. -89.9±9.1 HU; -77.5±8.4 vs. -85.6±7.9 HU, all P<0.001). The preoperative RCAPCATa, LADPCATa, and LCxPCATa values were higher in the AAD patients than the postoperative steady-state patients (-82.9±8.7 vs. -97.6±8.8 HU; -79.8±7.6 vs. -92.8±6.8 HU; -74.6±7.1 vs. -87.7±6.9 HU, all P<0.001). According to the multivariable logistic regression analysis, high RCAPCATa and LADPCATa values were associated with AAD regardless of the degree of stenosis [odds ratio (OR) =0.014; 95% confidence interval (CI): 0.001-0.177; P=0.001 and OR =0.010; 95% CI: 0.001-0.189; P=0.002].
Conclusions:
PCATa on computed tomography was increased in patients with AAD regardless of the presence or absence of coronary artery disease (CAD). This suggests that vascular inflammation is present in AAD independent of CAD. Further research should be conducted to investigate the potential of this imaging biomarker to predict AAD and monitor patients' responses to therapies for AAD.
