Pre‐percutaneous Coronary Intervention Pericoronary Adipose Tissue Attenuation Evaluated by Computed Tomography Predicts Global Coronary Flow Reserve After Urgent Revascularization in Patients With Non–ST‐Segment–Elevation Acute Coronary Syndrome

Abstract

Background Impaired global coronary flow reserve (g‐CFR) is related to worse outcomes. Inflammation has been postulated to play a role in atherosclerosis. This study aimed to evaluate the relationship between pre‐procedural pericoronary adipose tissue inflammation and g‐CFR after the urgent percutaneous coronary intervention in patients with first non–ST‐segment–elevation acute coronary syndrome. Methods and Results Phase‐contrast cine‐magnetic resonance imaging was performed to obtain g‐CFR by quantifying coronary sinus flow at 1 month after percutaneous coronary intervention in a total of 116 first non–ST‐segment–elevation acute coronary syndrome patients who underwent pre‐percutaneous coronary intervention computed tomography angiography. On proximal 40‐mm segments of 3 major coronary vessels on computed tomography angiography, pericoronary adipose tissue attenuation was assessed by the crude analysis of mean computed tomography attenuation value. The patients were divided into 2 groups with and without impaired g‐CFR divided by the g‐CFR value of 1.8. There were significant differences in age, culprit lesion location, N‐terminal pro‐B‐type natriuretic peptide levels, high‐sensitivity C‐reactive protein (hs‐CRP) levels, mean pericoronary adipose tissue attenuation between patients with impaired g‐CFR and those without (g‐CFR, 1.47 [1.16, 1.68] versus 2.66 [2.22, 3.28]; P <0.001). Multivariable logistic regression analysis revealed that age (odds ratio [OR], 1.060; 95% CI, 1.012–1.111, P =0.015) and mean pericoronary adipose tissue attenuation (OR, 1.108; 95% CI, 1.026–1.197, P =0.009) were independent predictors of impaired g‐CFR (g‐CFR <1.8). Conclusions Mean pericoronary adipose tissue attenuation, a marker of perivascular inflammation, obtained by computed tomography angiography performed before urgent percutaneous coronary intervention, but not hs‐CRP, a marker of systemic inflammation was significantly associated with g‐CFR at 1‐month after revascularization. Our results may suggest the pathophysiological mechanisms linking perivascular inflammation and g‐CFR in patients with non–ST‐segment–elevation acute coronary syndrome.

Macrophage Polarization in the Perivascular Fat Was Associated With Coronary Atherosclerosis

“…Macrophages in the PvAT were previously associated with an increased risk of thrombosis in human coronary arteries. 13 Greater PvAT attenuation, which is a marker of PvAT inflammation in imaging exams, was independently associated with poorer global coronary reserve flow 1 month after an acute coronary event, 36 higher acute coronary syndrome, 37 and increased cardiac death. 38 Our stratified analyses demonstrated that the inflammation mediated by M1 macrophages in the periplaque PvAT was associated with characteristics of plaque progression and destabilization in thrombosed coronary arteries, suggesting that M1 macrophages in the PvAT might influence the inflammation in acute coronary events.…”

Analysis of Predictive Model of Coronary Vulnerable Plaque under Hemodynamic Numerical Simulation

“…ese cytokines can regulate energy balance and hormone metabolism [18]. In the study of Kanaji et al (2020) [19], it was found that patients with non-ST-segment elevation ACS undergoing percutaneous coronary intervention for one month were related to ADP and coronary artery blood flow reserve (g-CFR) impairment. In the g-CFR impaired group, there were remarkable differences in the location of the crime lesion, the level of amino-terminal B-type natriuretic peptide precursor, the level of high-sensitivity c-reactive protein (hs-CRP), and the ADP around the coronary arteries.…”

Coronary flow reserve evaluated by phase-contrast cine cardiovascular magnetic resonance imaging of coronary sinus: a meta-analysis

“…1 ). Fourteen studies presented two populations each [ 9 , 11 , 15 – 17 , 23 , 25 , 27 , 29 , 31 , 32 , 34 , 47 , 49 ], while two studies presented four populations each [ 30 , 35 ]. Therefore, a total of 67 independent populations were included.…”

“…Therefore, a total of 67 independent populations were included. Among the 47 studies, 22 were from Japan [ 19 – 21 , 23 – 37 , 42 , 44 , 45 , 47 ], eight from the United States [ 7 , 14 , 22 , 40 , 41 , 48 , 51 , 55 ], five from Sweden [ 12 , 16 , 17 , 53 , 54 ], three from Germany and Sweden [ 11 , 15 , 46 ], two from Finland [ 38 , 39 ], and one each from Australia [ 18 ], France [ 43 ], Italy [ 9 ], Norway [ 13 ], Turkey [ 10 ], the United Kingdom [ 49 ], Switzerland [ 7 ], and the Netherlands [ 50 ]. Year of publication ranged from 1992 to 2022.…”