Association of perivascular fat attenuation on computed tomography and heart failure with preserved ejection fraction

Abstract

Aims: Heart failure with a preserved ejection fraction (HFpEF) is associated with chronic inflammation. We aimed to investigate the association between pericoronary adipose tissue attenuation (PCATA) on coronary computed tomography angiography as a novel noninvasive marker of pericoronary inflammation and the presence of HFpEF.

Methods and results: This retrospective study included 607 outpatients (median age, 65 years; 50% male) who underwent both echocardiography and coronary computed tomography angiography. Patients with obstructive coronary artery disease were excluded from this study. PCATA was compared between patients with and without HFpEF, which was diagnosed according to the Heart Failure Association (HFA)-PEFF score. PCATA was assessed at the proximal 40-mm segments of all three major coronary arteries on coronary computed tomography angiography. Patients with HFpEF had higher PCATA in all coronary arteries compared to the control participants: left anterior descending artery (LAD), -65.2 ± 6.9 Hounsfield units (HU) vs. -68.1 ± 6.7 HU; left circumflex artery (LCX), -62.7 ± 6.8 HU vs. -65.4 ± 6.6 HU; and right coronary artery (RCA), -63.6 ± 8.5 HU vs. -65.5 ± 7.7 HU (P < 0.01). Multivariate logistic regression analysis, including conventional risk factors, revealed that PCATA per standard deviation in the LAD (odds ratio [OR], 1.449; 95% confidence interval [CI], 1.152-1.823), LCX (OR, 1.634; 95% CI, 1.283-2.081), and RCA (OR, 1.388; 95% CI, 1.107-1.740) were independently associated with HFpEF. The association between PCATA and HFpEF was mostly consistent across various patient clinical characteristics. The left ventricular mass and left atrial volume index showed a mild correlation with LAD-PCATA (ρ = 0.13 [P < 0.01] and ρ = 0.24 [P < 0.01]) and LCX-PCATA (ρ = 0.16 [P < 0.01] and ρ = 0.23 [P < 0.01]).

Conclusions: High PCATA score was significantly associated with the presence of HFpEF. Our results suggest that inflammation in the pericoronary artery adipose tissue is one of the underlying mechanisms of HFpEF.

Keywords: Adipose tissue; Computed tomography; Coronary artery; Heart failure; Inflammation.

Figure 1

The study flow diagram. CCTA, coronary computed tomography angiography; LVEF, left ventricular ejection fraction; CAD, coronary artery disease; HF, heart failure; HFA, heart failure; HFpEF, heart failure with preserved ejection fraction.

Figure 2

Representative case of pericoronary adipose tissue attenuation (PCATA) measured by coronary computed tomography (CT) angiography. Semi‐automated software measurements showing colour coded PCATA in longitudinal view (A) and axial view (B) around the proximal 10–50 mm of the right coronary artery. PCATA was defined as the mean CT attenuation value (−190 to −30 HU) within a radial distance equal to the diameter of the vessel. Histogram of CT attenuation within the traced area demonstrates that the PCATA in the right coronary artery was −84.7 HU in these patients.

Figure 3

Comparison of pericoronary adipose tissue attenuation (PCATA) between patients who had heart failure with preserved ejection fraction (HFpEF) and control. (A) Comparison of the left anterior descending artery (LAD)‐PCATA between the two groups. LAD‐PCATA in the number of patients with HFpEF (indicated with pink dots) was higher than that in the control (indicated with blue dots). (B) Comparison of the left circumflex coronary artery (LCX)‐PCATA between the two groups. LCX‐PCATA in patients with HFpEF is higher than that in the control. (C) Comparison of the right coronary artery (RCA)‐PCATA between the two groups. RCA‐PCATA in patients with HFpEF is higher than that in the control.

Figure 4

The association of pericoronary adipose tissue attenuation (PCATA) in those who had heart failure with preserved ejection fraction (HFpEF) between subgroups. Patients were categorised into two groups based on the cutoff value of LAD‐PCATA of −70.4 HU for discriminating between patients with and without HFpEF. ACE‐I, angiotensin‐converting enzyme inhibitor; ARB, angiotensin‐receptor blocker; BMI, body mass index; LAD, left anterior descending artery.