The aim of our study was to investigate the correlation between volumes of thoracic fat distributed in different compartments and the geometry of vulnerable coronary plaques assessed by coronary computed tomography angiography (CCTA), in patients with acute chest pain.
Methods: This was a non-randomized, observational, single-center study, including 50 patients who presented in the emergency department with acute chest pain who underwent 128-slice single-source CCTA. Plaque geometry was evaluated in transversal and longitudinal planes, and the assessment of adipose tissue was performed using the Syngo.via Frontier (Siemens AG, Healthcare Sector, Forchheim, Germany) research platform.
Results: Eccentric plaques presented a significantly higher incidence of spotty calcification (40% vs. 22%, p = 0.018), whereas positive remodeling, volume of low attenuation plaque, and incidence of napkin-ring sign were not significantly different between the study groups or in ascending versus descending plaques. The volume of pericoronary fat around the plaque was significantly larger near eccentric lesions (707.68 ± 454.08 mm3 vs. 483.25 ± 306.98 mm3, p = 0.046) and descendent plaques (778.26 ± 479.37 mm3 vs. 473.60 ± 285.27 mm3, p = 0.016). Compared to ascending lesions, descendent ones presented a significantly larger volume of thoracic fat (1,599.25 ± 589.12 mL vs. 1,240.71 ± 291.50 mL), while there was no significant correlation between thoracic fat and cross-sectional eccentricity.
Conclusions: The phenotype of plaque distribution and geometry seems to be associated with a higher vulnerability of coronary lesions and may be influenced by the local accumulation of inflammatory mediators released by the pericoronary epicardial adipose tissue.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Pozo E Agudo-Quilez P Rojas-Gonzales A et al. Noninvasive diagnosis of vulnerable coronary plaque. World J Cardiol. 2016;8:520-533. doi: 10.4330/wjc.v8.i9.520.
2. Benedek T Gyongyosi M Benedek I. Multislice computed tomographic coronary angiography for quantitative assessment of culprit lesions in acute coronary syndromes. Can J Cardiol. 2013;29:364-371. doi: 10.1016/j.cjca.2012.11.004.
3. Yamagishi M Terashima M Awano K et al. Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravscular ultrasound before an acute coronary syndrome. J Am Coll Cardiol. 2000;35:106-111.
4. Higuma T Soeda T Abe N et al. A Combined Optical Coherence Tomography and Intravascular Ultrasound Study on Plaque Rupture Plaque Erosion and Calcified Nodule in Patinets With ST-Segment Elevation Myocardial Infarction: Incidence Morphologic Characteristics and Outcomes After Percutaneous Coronary Intervention. JACC Cardiovasc Interv. 2015;8:1166-1176. doi: 10.1016/j.jcin.2015.02.026
5. Hedgire S Baliyan V Zucker EJ et al. Perivascular Epicardial Fat Stranding at Coronary CT Angiography: A Marker of Acute Plaque Rupture and Spontaneous Coronary Artery Dissection. Radiology. 2018;287:808-815. doi: 10.1148/radiol.2017171568.
6. Harada K Amano T Uetani T et al. Cardiac 64-multislice computed tomography reveals increased epicardial fat volume in patients with acute coronary syndrome. Am J Cardiol. 2011;108:1119-1123. doi: 10.1016/j.amjcard.2011.06.012.
7. Tamarappoo B Dey D Shmilovich H et al. Increased pericardial fat volume measured from noncontrast CT predicts myocardial ischemia by SPECT. JACC Cardiovasc Imaging. 2010;3:1104-1112. doi: 10.1016/j.jcmg.2010.07.014.
8. Mazurek T Zhang L Zalewski A et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003;108:2460-2466. doi: 10.1161/01.CIR.0000099542.57313.C5.
9. Mahabadi AA Massaro JM Rosito GA et al. Association of pericardial fat intrathoracic fat and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. Eur Heart J. 2009;30:850-856. doi: 10.1093/eurheartj/ehn573.
10. Ding J Hsu FC Harris TB et al. 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. doi: 10.3945/ajcn.2008.27358.
11. Nyulas T Morariu M Rat N et al. Epicardial Adipose Tissue Role as a Marker of Higher Vulnerability in Patients with Coronary Artery Disease. Journal of Interdisciplinary Medicine. 2018;3:77-83. doi: 10.2478/jim-2018-0018.
12. Rat N Opincariu D Blendea C et al. The Effect of Periplaque Fat on Coronary Plaque Vulnerability in Patients with Stabile Coronary Artery Disease – a 128-slice CT-based Study. Journal of Interdisciplinary Medicine. 2018;3:67-76. doi: 10.2478/jim-2018-0019.
13. Maurovich-Horvath P Kallianos K Engel LC et al. Influence of pericoronary adipose tissue on local coronary atherosclerosis as assessed by a novel MDCT volumetric method. Atherosclerosis. 2011;219:151-157. doi: 10.1016/j.atherosclerosis.2011.06.049.
14. Kang DY Ahn JM Kim YK et al. Impact of Coronary Lesion Geometry on fractional Flow Reserve: Data From International Cardiology Research In-Cooperation Society-Fractional Flow Reserve and Intravascular Ultrasound Registry. Circ Cardiovasc Imaging. 2018;11:e007087. doi: 10.1161/CIRCIMAGING.117.007087.
15. Jain S Biligi D. An Autopsy Study on Coronary Atherosclerosis with Morphological and Morphometric Analysis. Int J Sci Res. 2013;4:1522-1526.
16. Puri R Leong DP Nicholls SJ et al. Coronary artery wall shear stress is associated with endothelial dysfunction and expansive arterial remodelling in patients with coronary artery disease. EuroIntervention. 2015;10:1440-1448. doi: 10.4244/EIJV10I12A249.