Key result
Severe CAC links to ~11-point higher relative pericoronary adipose tissue attenuation vs zero CAC.
Why the study?
Absolute PCAT attenuation may be influenced by technical and inter-individual variability, and a standardized measurement methodology has not been established.
Does relative pericoronary adipose tissue (PCAT) attenuation correlate better with coronary artery calcification severity than raw PCAT attenuation in patients undergoing cardiac CT for suspected CAD?
Observational (n=200)
No
Does relative pericoronary adipose tissue (PCAT) attenuation correlate better with coronary artery calcification severity than raw PCAT attenuation in patients undergoing cardiac CT for suspected CAD?
Mean Difference: 10.68 (95% CI 3.3–18.06)
p-value: p=0.005
Normalizing pericoronary fat attenuation to subcutaneous fat may improve its utility as an independent imaging biomarker of coronary inflammation and calcification burden on non-contrast CT.
Relative PCAT attenuation may mark inflammation in severe CAC; leaves open its added prognostic value beyond CAC scoring.
Background and Objectives: Pericoronary adipose tissue (PCAT) attenuation measured on coronary CT angiography is a promising imaging biomarker of coronary inflammation; however, absolute values may be influenced by technical and inter-individual variability, and a standardized methodology for measurement has not been established. Our study aimed to evaluate the association between PCAT attenuation and CAC burden while comparing absolute attenuation values with normalized values to minimize these sources of variability. Materials and Methods: Two hundred patients undergoing cardiac CT were included and stratified into four CAC categories (0, 1–99, 100–299, ≥300). PCAT attenuation was measured at multiple locations on two main levels: aortic root level and four-chamber view level. Relative PCAT attenuation was calculated by subtracting subcutaneous fat attenuation from raw PCAT values. Group comparisons were performed using ANOVA or Kruskal–Wallis tests, and multivariable linear regression models were adjusted for age, sex, and body mass index. Results: In univariate analysis, relative PCAT attenuation differed significantly across CAC categories at the aortic-level right coronary artery (RCA) site (p = 0.007). In multivariable analysis, higher CAC categories were associated with increased relative PCAT attenuation at the aortic RCA (β = 8.56, p = 0.015 for CAC 100–299; β = 10.68, p = 0.005 for CAC ≥300), while associations at the left main coronary artery (LMCA) showed significance in low and moderate CAC categories (β = 6.91, p = 0.047 for CAC 1–99 and β = 8.57, p = 0.016 for CAC 100–299). No significant associations were observed between CAC and raw PCAT attenuation at the aortic level, while isolated and inconsistent findings were observed in other territories. Conclusions: Relative PCAT attenuation is independently associated with CAC severity and normalized values may reduce technical and biological variability, potentially enhancing the sensitivity and robustness of this CT-based biomarker.
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Lőrincz et al. (2026) conducted an observational in Suspected coronary artery disease (n=200). Severe coronary artery calcification (CAC ≥300) vs. No coronary artery calcification (CAC 0) was evaluated on Relative pericoronary adipose tissue (PCAT) attenuation at the aortic root right coronary artery (RCA) in multivariable linear regression (β = 10.68, 95% CI 3.30 to 18.06, p=0.005). Severe coronary artery calcification (CAC ≥300) was independently associated with a significant increase in relative pericoronary adipose tissue attenuation at the aortic right coronary artery (β = 10.68) compared to a CAC of 0.
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