Association between coronary high-intensity plaque and pericoronary adipose tissue attenuation and plaque morphology

This study aimed to investigate the association between high-intensity plaque (HIP) on cardiac magnetic resonance (CMR) imaging and pericoronary adipose tissue attenuation (PCATA) and plaque burden on coronary computed tomography angiography (CCTA) in patients with chronic coronary syndrome (CCS).

We retrospectively analyzed 104 coronary lesions in 86 patients with CCS who underwent CMR imaging and CCTA before elective percutaneous coronary intervention. HIP was defined as a plaque-to-myocardium signal intensity ratio (PMR) of ≥1.4 on T1-weighted CMR imaging. The PCATA of the target lesion was assessed, and the mean value was used for the analysis. The plaque morphology and volume of the target lesion were assessed on CCTA based on attenuation values and stratified into calcified, fibrous, fibrous-fatty, and low-attenuation plaques (LAPs).

Forty-five lesions were assigned to the HIP group (43%). The PCATA and LAP volume on CCTA were significantly higher in the HIP group than those in the non-HIP group (-69.3 Hounsfield units [HU] vs. -73.9 HU; p = 0.022; 27.4 mm³ vs. 7.2 mm³; p < 0.001). PMR was correlated with both PCATA and LAP volume. On adjusted multiple regression analysis, PCATA ≥ -67 HU and LAP volume were associated with HIP. The prevalence of HIP on CMR was the highest in the high PCATA and high LAP volume group and the lowest in the low PCATA and low LAP volume group.

HIP on CMR is associated with higher PCATA and larger LAP volume, linking coronary inflammation with plaque vulnerability.