Objective Dyslipidaemia promotes atherosclerosis, increasing the risk of premature major adverse cardiovascular events (MACE). Coronary artery calcium scoring (CACS) is currently first-line for imaging asymptomatic patients. We quantified the re-stratification of subclinical atherosclerosis burden in Lipid Clinic patients assessed with CACS vs CTCA vs pericoronary fat attenuation index (FAI) measurement of inflammation. Methods Analysis of a prospectively maintained database of asymptomatic Lipid Clinic patients undergoing CACS and CTCA (May 2019 -December 2020). CACS-defined Agatston score categories were compared with (i) CTCA-derived Coronary Artery Disease -Reporting and Data System (CAD-RADS) grading of stenosis, including a modifier for high-risk plaque (HRP), and (ii) FAI analysis. Results 45 asymptomatic patients (55±9 years, 49% female) were included. CTCA re-classified CAD severity vs CACS in 62% (28/45) patients (p=0.005). HRP features were observed in 31% (14/45) patients, including 23% (7/31) with a CACS £100. 19% (8/42) patients with FAI analysis had inflammation >75th percentile (any vessel) vs age-and sex-matched controls, including 22% (6/27) patients with a CACS £100. 71% (5/7) had CAD-RADS 0 or 1 and 43% (3/7) had HRP. High FAI was seen across all groups of CACS and CAD-RADS. The proportion with high FAI was higher in CAD-RADS 0 vs CAD-RADS 4, and CACS severity was not associated with level of inflammation (p=0.94). Conclusion CTCA re-stratifies CAD presence and severity vs CACS in high-risk, asymptomatic patients. FAI provides incremental value in identification of patients at risk of future MACE regardless of CACS grade, including patients without evidence of overt CAD.
Conclusion Our study suggests that loss of SMAD3 could possibly present a key event in the pathophysiology in PAH and restoring this pathway may provide therapeutic intervention.
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