Pericoronary Fat Attenuation Index Is Associated With Vulnerable Plaque Components and Local Immune-Inflammatory Activation in Patients With Non-ST Elevation Acute Coronary Syndrome

Jia Teng Sun, Xin Cheng Sheng, Qi Feng, Yan Yin, Zheng Li, Song Ding, Jun Pu, Jia Teng Sun, Xin Cheng Sheng, Qi Feng, Yan Yin, Zheng Li, Song Ding, Jun Pu

Abstract

Background The pericoronary fat attenuation index (FAI) is assessed using standard coronary computed tomography angiography, and it has emerged as a novel imaging biomarker of coronary inflammation. The present study assessed whether increased pericoronary FAI values on coronary computed tomography angiography were associated with vulnerable plaque components and their intracellular cytokine levels in patients with non-ST elevation acute coronary syndrome. Methods and Results A total of 195 lesions in 130 patients with non-ST elevation acute coronary syndrome were prospectively included. Lesion-specific pericoronary FAI, plaque components and other plaque features were evaluated by coronary computed tomography angiography. Local T cell subsets and their intracellular cytokine levels were detected by flow cytometry. Lesions with pericoronary FAI values >-70.1 Hounsfield units exhibited spotty calcification (43.1% versus 25.0%, P=0.015) and low-attenuation plaques (17.6% versus 4.2%, P=0.016) more frequently than lesions with lower pericoronary FAI values. Further quantitative plaque compositional analysis showed that increased necrotic core volume (Pearson's r=0.324, P<0.001) and fibrofatty volume (Pearson's r=0.270, P<0.001) were positively associated with the pericoronary FAI, and fibrous volume (Pearson's r=-0.333, P<0.001) showed a negative association. An increasing proinflammatory intracellular cytokine profile was found in lesions with higher pericoronary FAI values. Conclusions The pericoronary FAI may be a reliable indicator of local immune-inflammatory response activation, which is closely related to plaque vulnerability. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04792047.

Keywords: coronary computed tomography angiography; non‐ST elevation acute coronary syndromes; pericoronary fat attenuation index; vulnerable plaque.

Figures

Figure 1. Flowchart of patient enrollment.
Figure 1. Flowchart of patient enrollment.
ACS indicates acute coronary syndrome; CCTA, coronary computed tomography angiography; and FAI, fat attenuation index.
Figure 2. Example of coronary plaque quantitative…
Figure 2. Example of coronary plaque quantitative analysis and pericoronary FAI phenotyping of a lesion in the proximal LAD artery segment.
A, Longitudinal straightened multiplanar reconstruction, where “O” is the point of minimum lumen area. B, Cross‐sectional view at the point of minimum lumen area. C, Graph of lumen and vessel area as a function of vessel length. D, Straightened view of FAI phenotyping. E, Cross‐section view of FAI phenotyping. FAI indicates fat attenuation index; and LAD, left anterior descending.
Figure 3. Correlation between FAI values and…
Figure 3. Correlation between FAI values and mean plaque burden (A), fibrous volume (B), necrotic core volume (C), fibrous fatty volume (D).
FAI indicates fat attenuation index; and HU, Hounsfield unit.

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