Prognostic value of epicardial adipose tissue volume in combination with coronary plaque and flow assessment for the prediction of major adverse cardiac events

Brandt, Verena; Bekeredjian, Raffi; Schoepf, U. Joseph; Varga-Szemes, Ákos; Emrich, Tilman; Aquino, Gilberto; Decker, Josua A.; Bayer, Richard R.; Ellis, Lauren; Ebersberger, Ullrich; Tesche, Christian

doi:10.1016/j.ejrad.2022.110157

Cited by 14 publications

(14 citation statements)

References 44 publications

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“…Coronary CT angiography (CCTA) is the primary imaging modality for the non-invasive anatomical assessment of coronary artery disease ( 1 – 5 ). CCTA provides an excellent visualization of atherosclerotic plaques and enables the characterization of certain coronary plaque types ( 2 , 6 – 10 ). While macrocalcified plaques are considered to be relatively stable, low attenuation plaques, positive remodeling, the napkin ring sign, and spotty calcifications on CCTA have been associated with plaque instability ( 6 , 7 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

First in-human quantitative plaque characterization with ultra-high resolution coronary photon-counting CT angiography

Mergen

Eberhard

Manka

et al. 2022

Front. Cardiovasc. Med.

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PurposeTo assess the effect of ultra-high-resolution coronary CT angiography (CCTA) with photon-counting detector (PCD) CT on quantitative coronary plaque characterization.Materials and methodsIn this IRB-approved study, 22 plaques of 20 patients (7 women; mean age 77 ± 8 years, mean body mass index 26.1 ± 3.6 kg/m2) undergoing electrocardiography (ECG)-gated ultra-high-resolution CCTA with PCD-CT were included. Images were reconstructed with a smooth (Bv40) and a sharp (Bv64) vascular kernel, with quantum iterative reconstruction (strength level 4), and using a slice thickness of 0.6, 0.4, and 0.2 mm, respectively (field-of-view 200 mm × 200 mm, matrix size 512 × 512 pixels). Reconstructions with the Bv40 kernel and slice thickness of 0.6 mm served as the reference standard. After identification of a plaque in coronary arteries with a vessel diameter ≥2 mm, plaque composition was determined using a dedicated, semi-automated plaque quantification software. Total plaque, calcified, fibrotic, and lipid-rich plaque components were quantified in all datasets.ResultsMedian plaque volume was highest (23.5 mm3, interquartiles 17.9–34.3 mm3) for reconstructions with the reference standard and lowest for ultra-high-resolution reconstructions with a slice thickness of 0.2 mm and the Bv64 kernel (18.1 mm3, interquartiles 14.1–25.8 mm3, p < 0.001). Reconstructions with the reference standard showed largest calcified (85.1%, interquartiles 76.4–91.1%) and smallest lipid-rich plaque components (0.5%, interquartiles 0.0–1.5%). Smallest calcified plaque components (75.2%, interquartiles 69.9–80.8%) and largest lipid-rich components (6.7%, interquartiles 5.1–8.4%) were found for ultra-high-resolution reconstructions with a slice thickness of 0.2 mm and the Bv64 kernel. At an identical slice thickness, volume of calcified components was always lower, and volume of lipid-rich components was always higher for reconstructions with the Bv64 kernel compared with reconstructions with the Bv40 kernel (all, p < 0.001).ConclusionThis patient study indicates significant differences of ultra-high-resolution scanning with PCD-CT on quantitative coronary plaque characterization. Reduced blooming artifacts may allow improved visualization of fibrotic and lipid-rich plaque components with the ultra-high-resolution mode of PCD-CT.

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Section: Introductionmentioning

confidence: 99%

First in-human quantitative plaque characterization with ultra-high resolution coronary photon-counting CT angiography

Mergen

Eberhard

Manka

et al. 2022

Front. Cardiovasc. Med.

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“…It has been designated as a “promotor of atherosclerotic plaque progression and vulnerability” due to its significant impact on atherosclerosis genesis. 11 …”

Section: Discussionmentioning

confidence: 99%

The relation between pericoronary fat thickness and density quantified by coronary computed tomography angiography with coronary artery disease severity

Farag

Mostafa

Elrabbat

et al. 2023

Indian Heart Journal

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“…It remains controversial whether EAV enables the provision of prognostic information in patients with CAD ( 41 , 42 ). Gitsioudis et al ( 41 ) demonstrated that increased EAV (EAV ≥162.2 cm 3 ) is associated with coronary plaque burden and is a predictor of worse outcome independent of risk factors, although the increased EAV did not remain as an independent predictor when coronary artery luminal stenosis was included in the model.…”

Section: Discussionmentioning

confidence: 99%

“…Gitsioudis et al ( 41 ) demonstrated that increased EAV (EAV ≥162.2 cm 3 ) is associated with coronary plaque burden and is a predictor of worse outcome independent of risk factors, although the increased EAV did not remain as an independent predictor when coronary artery luminal stenosis was included in the model. Brandt et al demonstrated that EAT volume showed the improved prediction performance in addition to clinical risk score alone or its combination with CCTA findings ( 42 ). Contrastingly, CCTA-derived LAP has been validated by histopathology, demonstrating a close association between LAP and lipid core plaque ( 43 ) and outcomes, including mortality and non-fatal myocardial infarction ( 11 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

Determinants of Non-calcified Low-Attenuation Coronary Plaque Burden in Patients Without Known Coronary Artery Disease: A Coronary CT Angiography Study

Yamaura¹,

Otsuka

Ishikawa

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAlthough epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD), it is unclear whether EAT volume (EAV) can be used to diagnose high-risk coronary plaque burden associated with coronary events. This study aimed to investigate (1) the prognostic impact of low-attenuation non-calcified coronary plaque (LAP) burden on patient level analysis, and (2) the association of EAV with LAP volume in patients without known CAD undergoing coronary computed tomography angiography (CCTA).Materials and MethodsThis retrospective study consisted of 376 patients (male, 57%; mean age, 65.2 ± 13 years) without known CAD undergoing CCTA. Percent LAP volume (%LAP, <30 HU) was calculated as the LAP volume divided by the vessel volume. EAT was defined as adipose tissue with a CT attenuation value ranging from −250 to −30 HU within the pericardial sac. The primary endpoint was a composite event of death, non-fatal myocardial infarction, and unstable angina and worsening symptoms requiring unplanned coronary revascularization >3 months after CCTA. The determinants of %LAP (Q4) were analyzed using a multivariable logistic regression model.ResultsDuring the follow-up period (mean, 2.2 ± 0.9 years), the primary endpoint was observed in 17 patients (4.5%). The independent predictors of the primary endpoint were %LAP (Q4) (hazard ratio [HR], 3.05; 95% confidence interval [CI], 1.09–8.54; p = 0.033] in the Cox proportional hazard model adjusted by CAD-RADS category. Cox proportional hazard ratio analysis demonstrated that %LAP (Q4) was a predictor of the primary endpoint, independnet of CAD severity, Suita score, EAV, or CACS. The independent determinants of %LAP (Q4) were CACS ≥218.3 (p < 0.0001) and EAV ≥125.3 ml (p < 0.0001). The addition of EAV to CACS significantly improved the area under the curve (AUC) to identify %LAP (Q4) than CACS alone (AUC, EAV + CACS vs. CACS alone: 0.728 vs. 0.637; p = 0.013).ConclusionsCCTA-based assessment of EAV, CACS, and LAP could help improve personalized cardiac risk management by administering patient-suited therapy.

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Prognostic value of epicardial adipose tissue volume in combination with coronary plaque and flow assessment for the prediction of major adverse cardiac events

Cited by 14 publications

References 44 publications

First in-human quantitative plaque characterization with ultra-high resolution coronary photon-counting CT angiography

First in-human quantitative plaque characterization with ultra-high resolution coronary photon-counting CT angiography

The relation between pericoronary fat thickness and density quantified by coronary computed tomography angiography with coronary artery disease severity

Determinants of Non-calcified Low-Attenuation Coronary Plaque Burden in Patients Without Known Coronary Artery Disease: A Coronary CT Angiography Study

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