Epicardial and Pericoronary Adipose Tissue, Coronary Inflammation, and Acute Coronary Syndromes.
Gianluigi NapoliValeria PergolaPaolo BasileDaniele De FeoFulvio BertrandinoAndrea BaggianoSaima MushtaqLaura FusiniFabio FazzariNazario CarrabbaMark G RabbatRaffaella MottaMarco Matteo CicconeGianluca PontoneAndrea Igoren GuaricciPublished in: Journal of clinical medicine (2023)
Vascular inflammation is recognized as the primary trigger of acute coronary syndrome (ACS). However, current noninvasive methods are not capable of accurately detecting coronary inflammation. Epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT), in addition to their role as an energy reserve system, have been found to contribute to the development and progression of coronary artery calcification, inflammation, and plaque vulnerability. They also participate in the vascular response during ischemia, sympathetic stimuli, and arrhythmia. As a result, the evaluation of EAT and PCAT using imaging techniques such as computed tomography (CT), cardiac magnetic resonance (CMR), and nuclear imaging has gained significant attention. PCAT-CT attenuation, which measures the average CT attenuation in Hounsfield units (HU) of the adipose tissue, reflects adipocyte differentiation/size and leukocyte infiltration. It is emerging as a marker of tissue inflammation and has shown prognostic value in coronary artery disease (CAD), being associated with plaque development, vulnerability, and rupture. In patients with acute myocardial infarction (AMI), an inflammatory pericoronary microenvironment promoted by dysfunctional EAT/PCAT has been demonstrated, and more recently, it has been associated with plaque rupture in non-ST-segment elevation myocardial infarction (NSTEMI). Endothelial dysfunction, known for its detrimental effects on coronary vessels and its association with plaque progression, is bidirectionally linked to PCAT. PCAT modulates the secretory profile of endothelial cells in response to inflammation and also plays a crucial role in regulating vascular tone in the coronary district. Consequently, dysregulated PCAT has been hypothesized to contribute to type 2 myocardial infarction with non-obstructive coronary arteries (MINOCA) and coronary vasculitis. Recently, quantitative measures of EAT derived from coronary CT angiography (CCTA) have been included in artificial intelligence (AI) models for cardiovascular risk stratification. These models have shown incremental utility in predicting major adverse cardiovascular events (MACEs) compared to plaque characteristics alone. Therefore, the analysis of PCAT and EAT, particularly through PCAT-CT attenuation, appears to be a safe, valuable, and sufficiently specific noninvasive method for accurately identifying coronary inflammation and subsequent high-risk plaque. These findings are supported by biopsy and in vivo evidence. Although speculative, these pieces of evidence open the door for a fascinating new strategy in cardiovascular risk stratification. The incorporation of PCAT and EAT analysis, mainly through PCAT-CT attenuation, could potentially lead to improved risk stratification and guide early targeted primary prevention and intensive secondary prevention in patients at higher risk of cardiac events.
Keyphrases
- coronary artery disease
- percutaneous coronary intervention
- cardiovascular events
- adipose tissue
- st segment elevation myocardial infarction
- acute myocardial infarction
- coronary artery
- oxidative stress
- computed tomography
- acute coronary syndrome
- coronary artery bypass grafting
- artificial intelligence
- contrast enhanced
- image quality
- dual energy
- antiplatelet therapy
- magnetic resonance
- insulin resistance
- positron emission tomography
- left ventricular
- endothelial cells
- high resolution
- aortic stenosis
- heart failure
- high fat diet
- magnetic resonance imaging
- stem cells
- drug delivery
- pulmonary artery
- big data
- chronic kidney disease
- skeletal muscle
- deep learning
- working memory
- type diabetes
- electronic health record
- blood flow
- data analysis