Impact of pericoronary adipose tissue attenuation and coronary microvascular dysfunction on cardiac remodeling and
Mai Katsura1, Yu Horiuchi2, Daiki Yoshiura1
1Division of Cardiology, Mitsui Memorial Hospital, 1 Kandaizumi-Cho, Chiyoda-Ku, Tokyo, 101-8643, Japan.
Insights
Coronary inflammation, not microvascular dysfunction or spasm, significantly impacts cardiac remodeling and function in ANOCA patients. Inflammation is linked to left ventricular changes, while dysfunction affects the left atrium.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Physiology
Background:
- Patients with angina and non-obstructive coronary artery disease (ANOCA) often experience cardiac remodeling and dysfunction.
- The roles of coronary inflammation, coronary microvascular dysfunction (CMD), and coronary artery spasm (CAS) in ANOCA pathophysiology require further elucidation.
Purpose of the Study:
- To investigate the independent and combined effects of coronary inflammation (PCAT attenuation - PCATA), CMD, and CAS on cardiac remodeling and dysfunction in patients with suspected ANOCA.
- To differentiate the contributions of these factors to adverse cardiac structural and functional changes.
Main Methods:
- Retrospective analysis of 257 ANOCA patients undergoing coronary spasm provocation testing.
- Coronary inflammation assessed via coronary CT angiography (PCATA).
- Coronary microvascular dysfunction diagnosed using invasive coronary physiology; coronary artery spasm assessed via provocation testing; cardiac remodeling and function evaluated using echocardiography (strain analysis, ventricular volumes, ejection fraction).
Main Results:
- Higher PCATA was significantly associated with increased left ventricular mass index, reduced left ventricular ejection fraction, and impaired right ventricular strain, independent of CMD.
- CMD was independently linked to increased left atrial volume index and impaired left atrial contraction strain.
- Coronary artery spasm (CAS) did not show a significant correlation with the assessed cardiac remodeling or dysfunction parameters.
Conclusions:
- Coronary inflammation (PCATA) is a significant independent predictor of left ventricular remodeling and dysfunction in ANOCA patients.
- Coronary microvascular dysfunction (CMD) is directly associated with left atrial remodeling and dysfunction.
- Coronary artery spasm plays a limited role in the observed cardiac remodeling and dysfunction in this ANOCA cohort.
Abstract:
We aimed to examine the impact of coronary inflammation, coronary microvascular dysfunction (CMD), and coronary artery spasm (CAS) on cardiac remodeling and dysfunction in patients suspected of angina with non-obstructive coronary artery disease (ANOCA). This retrospective single-center study included consecutive patients who underwent coronary spasm provocation testing between July 2020 and January 2025 for suspected ANOCA without prior revascularization and coronary stenosis ≥ 75%. Those who underwent coronary angiography after September 2022 also underwent invasive coronary physiology studies to diagnose structural CMD. PCAT attenuation (PCATA), reflecting coronary inflammation, was measured from prior coronary CT angiography, while strain analyses were obtained from prior echocardiography. Regression models were established between echocardiographic parameters and each of PCATA, CMD, and CAS. 257 patients (mean age, 64.2 ± 12.2 years; male, 62.1%) were included in the analysis. Multivariable regression analyses including PCATA, CMD, and CAS demonstrated that higher PCATA was associated with higher left ventricular mass index (β = 0.25, p = 0.007), reduced left ventricular ejection fraction (β = -0.21, p = 0.01), and impaired right ventricular four-chamber strain (β = 0.21, p = 0.04). CMD was independently associated with higher left atrial volume index (β = 0.67, p = 0.002) and impaired left atrial contraction strain (β = 5.31, p = 0.009). CAS showed no correlation with these parameters. Our study demonstrated a significant association between PCATA and left ventricular remodeling and dysfunction independent of CMD. It also revealed a direct relationship between CMD and left atrial remodeling and dysfunction.
More Related Videos
08:41Assessment of Vascular Tone Responsiveness using Isolated Mesenteric Arteries with a Focus on Modulation by Perivascular Adipose Tissues
Published on: June 3, 2019
06:26Multilevel Microdissection and Functional-Structural Profiling of Human Renal Arterial Branches
Published on: September 5, 2025
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:17Pathophysiology of Heart Failure
01:21Myocarditis I: Introduction
01:29Heart Failure II: Pathophysiology