Clinical Value and Time Course of Pericoronary Fat Inflammation in Patients with Angiographically Nonobstructive Coronaries: A Preliminary Report

Abstract

The introduction of high-sensitivity cardiac troponin allowed identifying a proportion of subjects with chest pain and electrocardiographic changes suggestive of myocardial infarction showing <50% coronary artery stenosis. PFAI is a coronary CT marker proved to predict outcome in ischemic heart disease. Based on CMR findings, patients were divided into myocarditis (n = 15), MINOCA (n = 14) and TTS (n = 9) groups. The aim was to estimate the value of pFAI in these groups compared to 12 controls. To evaluate the coronary inflammation “time course,” 20 patients underwent CMR and coronary CT scan within 8 days from the onset, the others within 60 days. There were higher values of pFAI in myocarditis (−86.45 HU), MINOCA (−84.63 HU) and TTS (−84.79 HU) compared to controls (−96.02 HU; p = 0.0077). Among patients who underwent CT within 8 days from onset, the MINOCA had a significantly higher pFAI value (−76.91 HU) compared to the control group (−96.02 HU; p = 0.0001). In the group that underwent CT later than 8 days, elevated pFAI values persisted only in the myocarditis and TTS groups, and there was no difference between MINOCA and controls. Our study shows that in patients with a diagnosis of MINOCA, there is acute coronary inflammation, which is more evident within one week from the acute event but tends to disappear with time.

The impact of diabetes mellitus on the outcome of troponin-positive patients with non-obstructive coronary arteries

“…As diabetes mellitus is a chronic disease with various potential long-term effects, this is consistent with our findings [14] . In MINOCA patients, the absence of obstructive CAD, as otherwise often associated with coronary artery manifestations of atherosclerosis in diabetic patients [14] , may indicate the presence of alternative pathways that may contribute to the pathogenesis of altered coronary arteries and consequently myocardial ischemia in these patients [23] , [24] , [25] , [26] . Chronic inflammatory processes, insulin resistance, and diabetes mellitus-promoted hypercoagulability could be possible pathophysiological pathways in MINOCA patients with diabetes mellitus [27] , [28] .…”

Added Value of CCTA-Derived Features to Predict MACEs in Stable Patients Undergoing Coronary Computed Tomography

“…Due to the relatively high occurrence and severity of events in patients with non-obstructive CAD [ 13 , 14 , 15 , 16 ], the incorporation of CCTA into clinical decision-making can be of great importance for improved identification of adverse events. The main finding of our study is that there is a positive correlation between CTCA-derived features and MACEs in our very selected population of patients with mild to moderate CAD.…”

“…There is also increasing evidence that pericoronary fat inflammation (pFAI) measured in the right coronary artery (RCA) is an independent predictor of cardiovascular events and mortality [ 12 , 13 , 14 , 15 , 16 , 17 ]. In addition, other evidence exists about the role of elevated pFAI in patients with myocarditis, myocardial infarction with nonobstructive coronary arteries (MINOCA) and Takotsubo syndrome [ 13 , 14 ]. Indeed, pericoronary adipose tissue releases proinflammatory cytokines that can alter the structure of the coronary wall, leading to CAD [ 15 ].…”

Assessment of Coronary Inflammation by Pericoronary Fat Attenuation Index in Clinically Suspected Myocarditis with Infarct-Like Presentation

“…We have recently reported lower pFAI values among patients with myocarditis, as compared to patients with myocardial infarction with non-obstructed coronaries (MINOCA) and Tako-Tsubo syndrome [ 20 ]. In the present cohort, RCA mean pFAI values are similar to those provided by Ma et al in patients without coronary plaques on CCTA and to a cohort of healthy controls [ 16 ].…”