- •The CT value of non-contrast CT (NC-PCAT) is correlated with that of conventional pericoronary adipose tissue (PCAT) .
- •High NC-PCAT value is associated with presence of high-risk plaque.
- •NC-PCAT is a significant predictor of worse clinical outcome in coronary artery disease patients.
Background and aims
We aimed to develop a method for quantifying pericoronary adipose tissue (PCAT) on electrocardiogram (ECG)-gated non-contrast CT (NC-PCAT) and validate its efficacy and prognostic value.
We retrospectively studied two independent cohorts. PCAT was quantified conventionally. NC-PCAT was defined as the mean CT value of epicardial fat tissue adjacent to right coronary artery ostium on ECG-gated non-contrast CT. In cohort 1 (n = 300), we evaluated the correlation of two methods and the association between NC-PCAT and CT-verified high-risk plaque (HRP). We dichotomized cohort 2 (n = 333) by the median of NC-PCAT, and assessed the prognostic value of NC-PCAT for primary endpoint (all-cause death and non-fatal myocardial infarction) by Cox regression analysis. The median duration of follow-up was 2.9 years.
NC-PCAT was correlated with PCAT (r = 0.68, p<0.0001). In multivariable logistic regression analysis, high NC-PCAT (OR:1.06; 95%CI:1.03–1.10; p = 0.0001), coronary artery calcium score (CACS) (OR:1.01 per 10 CACS increase, 95%CI:1.00–1.02; p = 0.013), and current smoking (OR:2.58; 95%CI:1.03–6.49; p = 0.044) were independent predictors of HRP. Among patients with CACS>0 (n = 193), NC-PCAT (OR:1.06; 95%CI:1.03–1.10; p = 0.0002), current smoking (OR:3.02; 95%CI:1.17–7.82; p = 0.027), and male sex (OR:2.81; 95%CI:1.06–7.48; p = 0.028) were independent predictors of HRP, whereas CACS was not (p = 0.15). Multivariable Cox regression analysis revealed high NC-PCAT as an independent predictor of the primary endpoint, even after adjustment for sex and age (HR:4.3; 95%CI:1.2–15.2; p = 0.012).
There was a positive correlation between NC-PCAT and PCAT, with high NC-PCAT significantly associated with worse clinical outcome (independent of CACS) as well as presence of HRP.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Atherosclerosis
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Atherosclerosis — an inflammatory disease.N. Engl. J. Med. 1999; 340: 115-126
- Pericardial fat inflammation correlates with coronary artery disease.Atherosclerosis. 2010; 213: 649-655
- How big are coronary atherosclerotic plaques that rupture?.Circulation. 1996; 94: 2662-2666
- Imaging: perivascular fat - an unheralded informant of coronary inflammation.Nat. Rev. Cardiol. 2017; 14: 573-574
- Atherosclerotic plaque characterization by CT angiography for identification of high-risk coronary artery lesions: a comparison to optical coherence tomography.Eur. Heart J. Cardiovasc. Imag. 2015; 16: 373-379
- The high-risk criteria low-attenuation plaque <60 HU and the napkin-ring sign are the most powerful predictors of MACE: a long-term follow-up study.Eur. Heart J. Cardiovasc. Imag. 2017; 18: 772-779
- Use of high-risk coronary atherosclerotic plaque detection for risk stratification of patients with stable chest pain: a secondary analysis of the PROMISE randomized clinical trial.JAMA Cardiol. 2018; 3: 144-152
- The napkin-ring sign indicates advanced atherosclerotic lesions in coronary CT angiography.JACC Cardiovasc. Imag. 2012; 5: 1243-1252
- Coronary inflammation: why searching, how to identify and treat it.Eur. Heart J. Suppl. 2020; 22: E121-E124
- Detecting human coronary inflammation by imaging perivascular fat.Sci. Transl. Med. 2017; 9eaal2658
- Pericoronary adipose tissue attenuation assessed by dual-layer spectral detector computed tomography is a sensitive imaging marker of high-risk plaques.Quant. Imag. Med. Surg. 2021; 11: 2093-2103
- Pericoronary adipose tissue attenuation is associated with high-risk plaque and subsequent acute coronary syndrome in patients with stable coronary artery disease.Cells. 2021; 10
- Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data.Lancet. 2018; 392: 929-939
- ESC Guidelines for the diagnosis and management of chronic coronary syndromes.Eur. Heart J. 2019; 41 (2020): 407-477
- AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American heart association joint committee on clinical practice guidelines.J. Am. Coll. Cardiol. 2021; 78 (2021): e187-e285
- Perivascular fat attenuation index on non-contrast-enhanced cardiac computed tomography: comparison with coronary computed tomography angiography.Open J. Radiol. 2020; 10 (03): 138-148
- Feasibility of measuring pericoronary fat from precontrast scans: effect of iodinated contrast on pericoronary fat attenuation.J. Cardiovasc. Comput. Tomogr. 2020; 14: 490-494
- Non-contrast CT-based radiomic signature of pericoronary adipose tissue for screening non-calcified plaque.Phys. Med. Biol. 2022; 67
- Quantification of coronary artery calcium using ultrafast computed tomography.J. Am. Coll. Cardiol. 1990; 15: 827-832
- Quantification of epicardial fat using non contrast cardiac CT in an HIV population: reproducibility and association with other body fat indices.Eur. J. Radiol. Open. 2021; 8100317
- Deep learning for quantification of epicardial and thoracic adipose tissue from non-contrast CT.IEEE Trans. Med. Imag. 2018; 37: 1835-1846
- Relationship between changes in pericoronary adipose tissue attenuation and coronary plaque burden quantified from coronary computed tomography angiography.Eur. Heart J. Cardiovasc. Imag. 2019; 20: 636-643
- CAD-RADS(TM) coronary artery disease - reporting and data system. An expert consensus document of the society of cardiovascular computed tomography (SCCT), the American College of Radiology (ACR) and the North American Society for cardiovascular imaging (NASCI). Endorsed by the American College of Cardiology.J. Cardiovasc. Comput. Tomogr. 2016; 10: 269-281
- Society of cardiovascular computed tomography/North American Society of cardiovascular imaging - expert consensus document on coronary CT imaging of atherosclerotic plaque.J. Cardiovasc. Comput. Tomogr. 2021; 15: 93-109
- Fourth Universal Definition of myocardial infarction (2018).Circulation. 2018; 138: e618-e651
- The association of pericardial fat with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis (MESA).Am. J. Clin. Nutr. 2009; 90: 499-504
- Quantification of epicardial adipose tissue by cardiac CT: influence of acquisition parameters and contrast enhancement.Eur. J. Radiol. 2019; 121108732
- Evaluation of coronary plaque characteristics with coronary computed tomography angiography in patients with non-obstructive coronary artery disease: a long-term follow-up study.Eur. Heart J. Cardiovasc. Imag. 2017; 18: 1170-1178
- High-risk coronary artery plaque in asymptomatic patients with type 2 diabetes: clinical risk factors and coronary artery calcium score.Cardiovasc. Diabetol. 2021; 20: 164
- Anti-inflammatory therapy for cardiovascular disease.Ann. Transl. Med. 2019; 7: 147
- Antiinflammatory therapy with Canakinumab for atherosclerotic disease.N. Engl. J. Med. 2017; 377: 1119-1131
- Colchicine therapy and plaque stabilization in patients with acute coronary syndrome: a CT coronary angiography study.JACC Cardiovasc. Imag. 2018; 11: 305-316
- Low-dose colchicine for secondary prevention of cardiovascular disease.J. Am. Coll. Cardiol. 2013; 61: 404-410
Published online: January 30, 2023
Accepted: January 24, 2023
Received in revised form: December 16, 2022
Received: September 28, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 Elsevier B.V. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- No contrast? No problem! Value in assessing pericoronary fat in non-contrast studiesAtherosclerosis
- PreviewIn this issue of Atherosclerosis, Takahashi et al. present a novel method for quantifying pericoronary adipose tissue (PCAT) attenuation on non-contrast chest computed tomography (NC-PCAT) scans performed for coronary artery calcium score (CACS) assessment. They also assessed its efficacy and utility as a prognostic tool . The authors divided the study population into two cohorts. Cohort 1 (N = 300 consecutive patients with previous CCTA) was used to assess the correlation between PCAT on non-contrast chest CT and coronary CT angiography (CCTA) and then the association between NC-PCAT and high-risk plaques (HRP).