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Review
. 2019 Nov 19;21(12):47.
doi: 10.1007/s11883-019-0817-3.

Perivascular Adipose Tissue and Coronary Atherosclerosis: from Biology to Imaging Phenotyping

Andrew Lin  1   2   3 , Damini Dey  3 , Dennis T L Wong  1   2 , Nitesh Nerlekar  4   5
Affiliations
Review

Perivascular Adipose Tissue and Coronary Atherosclerosis: from Biology to Imaging Phenotyping

Andrew Lin et al. Curr Atheroscler Rep. .

Abstract

Purpose of review: Perivascular adipose tissue (PVAT) has a complex, bidirectional relationship with the vascular wall. In disease states, PVAT secretes pro-inflammatory adipocytokines which may contribute to atherosclerosis. Recent evidence demonstrates that pericoronary adipose tissue (PCAT) may also function as a sensor of coronary inflammation. This review details PVAT biology and its clinical translation to current imaging phenotyping.

Recent findings: PCAT attenuation derived from routine coronary computed tomography (CT) angiography is a novel noninvasive imaging biomarker of coronary inflammation. Pro-inflammatory cytokines released from the arterial wall diffuse directly into the surrounding PCAT and inhibit adipocyte lipid accumulation in a paracrine manner. This can be detected as an increased PCAT CT attenuation, a metric which associates with high-risk plaque features and independently predicts cardiac mortality. There is also evidence that PCAT attenuation relates to coronary plaque progression and is modified by systemic anti-inflammatory therapies. Due to its proximity to the coronary arteries, PCAT has emerged as an important fat depot in cardiovascular research. PCAT CT attenuation has the potential to improve cardiovascular risk stratification, and future clinical studies should examine its role in guiding targeted medical therapy.

Keywords: Atherosclerosis; Cardiac computed tomography angiography; Inflammation; Perivascular adipose tissue.

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Conflict of interest statement

Conflict of Interest Andrew Lin, Damini Dey, Dennis T.L. Wong, and Nitesh Nerlekar declare they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Pericoronary adipose tissue—from biology to imaging phenotyping. a Bidirectional communication between PCAT and the coronary arterial wall. Dysfunctional PCAT secretes pro-inflammatory adipocytokines which diffuse directly into the vessel wall and contribute to atherosclerosis via paracrine and vasocrine mechanisms. The recent discovery of “inside-to-outside” signaling pathways demonstrates that PCAT can also function as a sensor of coronary inflammation. b Schematic representation of PCAT (red) surrounding the 3 major coronary arteries in a 3D anatomical model generated from CCTA. c PCAT quantification on CCTA using semi-automated software (Autoplaque v2.5). Left-sided panels show the proximal segment of the RCA (10–50 mm from RCA ostium) in curved and cross-sectional views, with PCAT visualized within a 3-mm radius around the vessel on a color map (Hounsfield unit scale inset). Right-sided panels show plaque quantification in the proximal RCA (non-calcified plaque in red overlay and calcified in yellow overlay) and the corresponding PCAT color map. d 3D rendering of a PCAT “heat map” around the proximal RCA
See this image and copyright information in PMC

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