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. 2019 Jun 1;20(6):636-643.
doi: 10.1093/ehjci/jez013.

Relationship between changes in pericoronary adipose tissue attenuation and coronary plaque burden quantified from coronary computed tomography angiography

Markus Goeller  1   2 , Balaji K Tamarappoo  3 , Alan C Kwan  3 , Sebastien Cadet  3 , Frederic Commandeur  1 , Aryabod Razipour  1 , Piotr J Slomka  3 , Heidi Gransar  3 , Xi Chen  3 , Yuka Otaki  3 , John D Friedman  3 , J Jane Cao  4 , Moritz H Albrecht  5 , Daniel O Bittner  2 , Mohamed Marwan  2 , Stephan Achenbach  2 , Daniel S Berman  3 , Damini Dey  1
Affiliations

Relationship between changes in pericoronary adipose tissue attenuation and coronary plaque burden quantified from coronary computed tomography angiography

Markus Goeller et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Increased attenuation of pericoronary adipose tissue (PCAT) around the proximal right coronary artery (RCA) from coronary computed tomography angiography (CTA) has been shown to be associated with coronary inflammation and improved prediction of cardiac death over plaque features. Our aim was to investigate whether PCAT CT attenuation is related to progression of coronary plaque burden.

Methods and results: We analysed CTA studies of 111 stable patients (age 59.2 ± 9.8 years, 77% male) who underwent sequential CTA (3.4 ± 1.6 years between scans) with identical acquisition protocols. Total plaque (TP), calcified plaque (CP), non-calcified plaque (NCP), and low-density non-calcified plaque (LD-NCP) volumes and corresponding burden (plaque volume × 100%/vessel volume) were quantified using semi-automated software. PCAT CT attenuation (HU) was measured around the proximal RCA, the most standardized method for PCAT analysis. Patients with an increase in NCP burden (n = 51) showed an increase in PCAT attenuation, whereas patients with a decrease in NCP burden (n = 60) showed a decrease {4.4 [95% confidence interval (CI) 2.6-6.2] vs. -2.78 (95% CI -4.6 to -1.0) HU, P < 0.0001}. Changes in PCAT attenuation correlated with changes in the burden of NCP (r = 0.55, P < 0.001) and LD-NCP (r = 0.24, P = 0.01); but not CP burden (P = 0.3). Increased baseline PCAT attenuation ≥-75 HU was independently associated with increase in NCP (odds ratio 3.07, 95% CI 1.4-7.0; P < 0.008) and TP burden on follow-up CTA.

Conclusion: PCAT attenuation measured from routine CTA is related to the progression of NCP and TP burden. This imaging biomarker may help to identify patients at increased risk of high-risk plaque progression and allow monitoring of beneficial changes from medical therapy.

Keywords: CT attenuation; coronary CT angiography; coronary plaque progression; inflammation; pericoronary adipose tissue.

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Figures

Figure 1
Figure 1
Overview of the method to quantify coronary plaque and PCAT. (A) Panel shows the proximal segment of the RCA (10–50 mm from RCA ostium) in a straightened view. (B) Panel shows a cross-sectional view of the proximal RCA. (C) Panel shows the proximal segment of the RCA with NCP highlighted in red colour (straightened view). (D) Panel shows the proximal RCA with NCP highlighted in red colour (cross-sectional view). (E) Panel shows PCAT quantification within a diameter of 3 mm around the proximal RCA (straightened view); PCAT is visualized using adipose tissue Hounsfield unit color table shown with color bar. (F) Panel shows PCAT quantification within a diameter of 3 mm around the proximal RCA (cross-sectional view).
Figure 2
Figure 2
A case example for a 73-year-old male patient with hyperlipidaemia and hypertension (BMI 24 kg/m2, interval between scans 2.5 years). Quantified PCAT and coronary plaque from CTA are shown: baseline (A–C) and follow-up (D–F); PCAT is visualized with adipose tissue HU color table shown with color bars in (A) and (D). (A) Curved mutiplanar view showing PCAT quantification of the proximal RCA (baseline). (B) Straightened and corresponding cross-sectional views of PCAT (baseline) are shown. (C) Coronary plaque in the RCA, NCP in red overlay, and CP in yellow overlay (baseline). (D) PCAT curved multiplanar view at follow-up. (E) Straightened and corresponding cross-sectional views of PCAT (follow-up). (F) Coronary plaque in the RCA (follow-up). There was plaque progression in this patient; NCP, CP, and TP burden were 36.3%, 13.6%, and 49.9% at baseline and 42.7%, 18.8%, and 61.5% at follow-up; baseline PCAT attenuation was increased (−74 HU). The follow-up PCAT attenuation was −67 HU.
Figure 3
Figure 3
A case example of a 61-year-old male patient with hyperlipidaemia (BMI 28 kg/m2) with a reduction in NCP burden and PCAT CT attenuation between baseline and follow-CTA is shown. Quantified PCAT and coronary plaque in the proximal RCA are shown: baseline (A–C) and follow-up (D–F); PCAT is visualized with the same adipose tissue HU color tables as in Figure 2. (A) Curved mutiplanar view showing PCAT quantification of the proximal RCA (baseline). (B) Straightened and corresponding cross-sectional views of PCAT (baseline). (C) Coronary plaque in the RCA, NCP in red overlay, and CP in yellow overlay (baseline). (D) PCAT curved multiplanar view at follow-up. (E) Straightened and corresponding cross-sectional views of PCAT (follow-up). (F) Coronary plaque in the RCA (follow-up).
Figure 4
Figure 4
Changes in PCAT CT attenuation in association with changes in characterized plaque burden. Increased NCP, LDN-CP, and TP burden were associated with an increase in PCAT CT attenuation, and the relationships persisted when adjusted for age, gender, number of risk factors, and changes in BMI and LDL.
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