Key result
Vasospastic angina is linked to increased coronary PVAT volume, adventitial inflammation, and Rho-kinase activity.
Why the study?
Perivascular adipose tissue and adventitial vasa vasorum are important sources of inflammatory mediators in cardiovascular disease, motivating the evaluation of whether coronary artery spasm is associated with perivascular inflammation in patients with vasospastic angina.
Is vasospastic angina associated with increased coronary adventitial and perivascular adipose tissue inflammation as assessed by 18F-FDG PET/CT and OCT compared to suspected angina without coronary spasm?
Observational (n=40)
Is vasospastic angina associated with increased coronary adventitial and perivascular adipose tissue inflammation as assessed by 18F-FDG PET/CT and OCT compared to suspected angina without coronary spasm?
This study provides the first clinical evidence that coronary artery spasm in vasospastic angina is associated with coronary adventitial and perivascular adipose tissue inflammation, which can be noninvasively assessed and monitored for treatment response using 18F-FDG PET/CT.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“However, in the current study, we were able to demonstrate that even CCBs alone could decrease coronary adventitial and adipose tissue inflammation in VSA patients”
“This finding may suggest that CTA could provide information related to the inflammation of the inner layer of pericoronary adipose tissue by virtue of its higher resolution compared with PET/CT, which is limited by low availability, high cost, and the requirement of a radioactive tracer.”
Vasospastic angina was associated with perivascular inflammation on PET/CT; hypothesis-generating and requires prospective validation before any clinical adoption.
Background Recent studies suggested that perivascular components, such as perivascular adipose tissue (PVAT) and adventitial vasa vasorum (VV), play an important role as a source of various inflammatory mediators in cardiovascular disease. Objectives The authors tested their hypothesis that coronary artery spasm is associated with perivascular inflammation in patients with vasospastic angina (VSA) using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). Methods This study prospectively examined 27 consecutive VSA patients with acetylcholine-induced diffuse spasm in the left anterior descending artery (LAD) and 13 subjects with suspected angina but without organic coronary lesions or coronary spasm. Using CT coronary angiography and electrocardiogram-gated 18F-FDG PET/CT, coronary PVAT volume and coronary perivascular FDG uptake in the LAD were examined. In addition, adventitial VV formation in the LAD was examined with optical coherence tomography, and Rho-kinase activity was measured in circulating leukocytes. Results Patient characteristics were comparable between the 2 groups. CT coronary angiography and ECG-gated 18F-FDG PET/CT showed that coronary PVAT volume and coronary perivascular FDG uptake significantly increased in the VSA group compared with the non-VSA group. Furthermore, optical coherence tomography showed that adventitial VV formation significantly increased in the VSA group compared with the non-VSA group, as did Rho-kinase activity. Importantly, during the follow-up period with medical treatment, both coronary perivascular FDG uptake and Rho-kinase activity significantly decreased in the VSA group. Conclusions These results provide the first evidence that coronary spasm is associated with inflammation of coronary adventitia and PVAT, where 18F-FDG PET/CT could be useful for disease activity assessment. (Morphological and Functional Change of Coronary Perivascular Adipose Tissue in Vasospastic Angina [ADIPO-VSA Trial]; UMIN000016675).
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Ohyama et al. (2018) conducted an observational in Vasospastic angina (n=40). Vasospastic angina (acetylcholine-induced diffuse LAD spasm) vs. Suspected angina without organic coronary lesions or coronary spasm was evaluated on Coronary PVAT volume, coronary perivascular 18F-FDG uptake, adventitial vasa vasorum formation in the LAD, and circulating leukocyte Rho-kinase activity. Vasospastic angina patients (n=27) had significantly higher coronary PVAT volume, perivascular 18F-FDG uptake, vasa vasorum formation, and Rho-kinase activity than controls (n=13).
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