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Updated: Jan 12, 2026
Assessment of Human Adipose Tissue Microvascular Function Using Videomicroscopy
Published on: September 29, 2017
Coronary perivascular adipose tissue fat attenuation index in patients with ischemia with no obstructive coronary
Nathaniel R Smilowitz1,2,3, Barbara Jerome1, David W Rhee1
1Leon H. Charney Division of Cardiology, Department of Medicine.
Insights
Coronary microvascular dysfunction (CMD) in ischemia with no obstructive coronary arteries (INOCA) was not associated with inflammation in the coronary perivascular adipose tissue. Coronary computed tomography angiography (CCTA) measures of inflammation did not correlate with invasive coronary function testing (CFT) results for CMD.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Coronary microvascular dysfunction (CMD) affects nearly half of patients with ischemia with no obstructive coronary arteries (INOCA).
- Inflammation in the coronary perivascular adipose tissue is a suspected contributor to CMD.
- Coronary computed tomography angiography (CCTA) offers a non-invasive method to assess this inflammation.
Purpose of the Study:
- To investigate the association between coronary perivascular adipose tissue inflammation, assessed by CCTA, and CMD diagnosed via invasive coronary function testing (CFT).
- To determine if CCTA-derived measures of inflammation correlate with invasive hemodynamic parameters of CMD in INOCA patients.
Main Methods:
- Prospective enrollment of adults undergoing coronary angiography with no obstructive epicardial disease.
- CMD diagnosis using invasive CFT: coronary flow reserve (CFR) < 2.5 or index of microvascular resistance (IMR) ≥ 25.
- Assessment of coronary perivascular fat attenuation index (FAI) using CCTA in the right coronary artery (RCA) and left anterior descending (LAD) artery.
Main Results:
- No significant differences in perivascular FAI were found between patients with and without CMD in either the RCA or LAD.
- Perivascular FAI measurements did not correlate with invasive CFR or IMR values.
- The study included 31 participants, with 48% diagnosed with CMD.
Conclusions:
- Invasive CFT-diagnosed CMD in INOCA patients showed no association with perivascular adipose tissue inflammation measured by CCTA.
- Further research is required to elucidate the complex relationship between vascular inflammation and CMD in the INOCA population.
Background:
Coronary microvascular dysfunction (CMD) is present in approximately 40% of patients with ischemia with no obstructive coronary arteries (INOCA) and has been associated with inflammation. We investigated associations between measures of inflammation of the coronary perivascular adipose tissue assessed by coronary computed tomography angiography (CCTA) and results of invasive coronary function testing (CFT) to diagnose CMD.
Methods:
Adults referred for clinically indicated invasive coronary angiography who had less than 50% stenosis in all epicardial arteries were prospectively enrolled. CMD was defined as a coronary flow reserve (CFR) less than 2.5 or index of microvascular resistance (IMR) greater than or equal to 25 using bolus thermodilution in the left anterior descending (LAD) coronary artery. Coronary perivascular fat attenuation index was assessed by CCTA in the right coronary artery (RCA) and LAD. T tests were used to evaluate differences in perivascular FAI by CMD status.
Results:
A total of 31 participants underwent CFT and CCTA. The mean age was 58 ± 11.7 years, 77% were female, and 61% were white. CMD was present in 15 participants (48%). No differences in perivascular FAI were observed in patients with and without CMD, either in the RCA [-74.2 ± 9.8 vs. -69.9 ± 10.3 Hounsfield units (HU), P = 0.24] or LAD (-76.4 ± 10.2 vs. -74.8 ± 12.7 HU, P = 0.69). Perivascular FAI was not correlated with CFR or IMR measurements in the RCA or LAD.
Conclusion:
There were no associations between CMD diagnosed by invasive CFT and perivascular FAI by CCTA in patients with INOCA. Further research is needed to understand the relationship between vascular inflammation and CMD in INOCA.
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