TY - JOUR
T1 - Characterization of plaque phenotypes exhibiting an elevated pericoronary adipose tissue attenuation
T2 - insights from the REASSURE-NIRS registry
AU - Kitahara, Satoshi
AU - Kataoka, Yu
AU - Miura, Hiroyuki
AU - Nishii, Tatsuya
AU - Nishimura, Kunihiro
AU - Murai, Kota
AU - Iwai, Takamasa
AU - Matama, Hideo
AU - Honda, Satoshi
AU - Fujino, Masashi
AU - Yoneda, Shuichi
AU - Takagi, Kensuke
AU - Otsuka, Fumiyuki
AU - Asaumi, Yasuhide
AU - Fujino, Yusuke
AU - Tsujita, Kenichi
AU - Puri, Rishi
AU - Nicholls, Stephen J.
AU - Noguchi, Teruo
N1 - Funding Information:
This work was supported by Fukuda Foundation for Medical Technology.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/10
Y1 - 2023/10
N2 - Inflammation has been considered to promote atheroma instability. Coronary computed tomography angiography (CCTA) visualizes pericoronary adipose tissue (PCAT) attenuation, which reflects coronary artery inflammation. While PCAT attenuation has been reported to predict future coronary events, plaque phenotypes exhibiting high PCAT attenuation remains to be fully elucidated. The current study aims to characterize coronary atheroma with a greater vascular inflammation. We retrospectively analyzed culprit lesions in 69 CAD patients receiving PCI from the REASSURE-NIRS registry (NCT04864171). Culprit lesions were evaluated by both CCTA and near-infrared spectroscopy/intravascular ultrasound (NIRS/IVUS) imaging prior to PCI. PCAT attenuation at proximal RCA (PCATRCA) and NIRS/IVUS-derived plaque measures were compared in patients with PCATRCA attenuation ≥ and < -78.3 HU (median). Lesions with PCATRCA attenuation ≥ -78.3 HU exhibited a greater frequency of maxLCBI4mm ≥ 400 (66% vs. 26%, p < 0.01), plaque burden ≥ 70% (94% vs. 74%, p = 0.02) and spotty calcification (49% vs. 6%, p < 0.01). Whereas positive remodeling (63% vs. 41%, p = 0.07) did not differ between two groups. On multivariable analysis, maxLCBI4mm ≥ 400 (OR = 4.07; 95%CI 1.12–14.74, p = 0.03), plaque burden ≥ 70% (OR = 7.87; 95%CI 1.01–61.26, p = 0.04), and spotty calcification (OR = 14.33; 95%CI 2.37–86.73, p < 0.01) independently predicted high PCATRCA attenuation. Of note, while the presence of only one plaque feature did not necessarily elevate PCATRCA attenuation (p = 0.22), lesions harboring two or more features were significantly associated with higher PCATRCA attenuation. More vulnerable plaque phenotypes were observed in patients with high PCATRCA attenuation. Our findings suggest PCATRCA attenuation as the presence of profound disease substrate, which potentially benefits from anti-inflammatory agents.
AB - Inflammation has been considered to promote atheroma instability. Coronary computed tomography angiography (CCTA) visualizes pericoronary adipose tissue (PCAT) attenuation, which reflects coronary artery inflammation. While PCAT attenuation has been reported to predict future coronary events, plaque phenotypes exhibiting high PCAT attenuation remains to be fully elucidated. The current study aims to characterize coronary atheroma with a greater vascular inflammation. We retrospectively analyzed culprit lesions in 69 CAD patients receiving PCI from the REASSURE-NIRS registry (NCT04864171). Culprit lesions were evaluated by both CCTA and near-infrared spectroscopy/intravascular ultrasound (NIRS/IVUS) imaging prior to PCI. PCAT attenuation at proximal RCA (PCATRCA) and NIRS/IVUS-derived plaque measures were compared in patients with PCATRCA attenuation ≥ and < -78.3 HU (median). Lesions with PCATRCA attenuation ≥ -78.3 HU exhibited a greater frequency of maxLCBI4mm ≥ 400 (66% vs. 26%, p < 0.01), plaque burden ≥ 70% (94% vs. 74%, p = 0.02) and spotty calcification (49% vs. 6%, p < 0.01). Whereas positive remodeling (63% vs. 41%, p = 0.07) did not differ between two groups. On multivariable analysis, maxLCBI4mm ≥ 400 (OR = 4.07; 95%CI 1.12–14.74, p = 0.03), plaque burden ≥ 70% (OR = 7.87; 95%CI 1.01–61.26, p = 0.04), and spotty calcification (OR = 14.33; 95%CI 2.37–86.73, p < 0.01) independently predicted high PCATRCA attenuation. Of note, while the presence of only one plaque feature did not necessarily elevate PCATRCA attenuation (p = 0.22), lesions harboring two or more features were significantly associated with higher PCATRCA attenuation. More vulnerable plaque phenotypes were observed in patients with high PCATRCA attenuation. Our findings suggest PCATRCA attenuation as the presence of profound disease substrate, which potentially benefits from anti-inflammatory agents.
KW - Anti-inflammatory agents
KW - Large plaque burden
KW - Lipid-rich plaque
KW - Positive remodeling
KW - Spotty calcification
UR - https://www.scopus.com/pages/publications/85163421819
U2 - 10.1007/s10554-023-02907-w
DO - 10.1007/s10554-023-02907-w
M3 - Article
C2 - 37380905
AN - SCOPUS:85163421819
SN - 1569-5794
VL - 39
SP - 1943
EP - 1952
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
IS - 10
ER -