March 18, 2022Open Access

High pericoronary adipose tissue attenuation on computed tomography angiography predicts cardiovascular events in patients with type 2 diabetes mellitus: post-hoc analysis from a prospective cohort study

KIKeishi IchikawaOkayama University TMToru MiyoshiOkayama University KOKazuhiro OsawaKawasaki Medical School

Structured PICO

Does high LAD-PCAT attenuation on coronary CTA predict cardiovascular events in patients with type 2 diabetes mellitus?

Population

333 Japanese outpatients with type 2 diabetes mellitus (T2DM) without a history of CAD who underwent clinically indicated coronary CTA for suspected stable CAD. Mean age 66, 63% male. Key exclusions: serum creatinine ≥ 1.5 mg/dL, history of cardiovascular events, active tumor, <1 year of follow-up, or poor image quality.

Intervention

High left anterior descending artery pericoronary adipose tissue (LAD-PCAT) attenuation (> -70.7 HU) assessed via coronary computed tomography angiography (CTA)

Comparator

Low LAD-PCAT attenuation (≤ -70.7 HU) assessed via coronary CTA

Outcome

Composite of cardiovascular events (cardiac death, hospitalisation for acute coronary syndrome, late coronary revascularisation, and hospitalisation for heart failure) at median 4.0 years follow-upcomposite

In patients with type 2 diabetes mellitus, high LAD-PCAT attenuation on coronary CTA provides incremental prognostic value beyond traditional adverse plaque features for predicting future cardiovascular events.

Abstract

BACKGROUND: Pericoronary adipose tissue (PCAT) attenuation on coronary computed tomography angiography (CTA) is a non-invasive biomarker for pericoronary inflammation. We aimed to investigate the prognostic value of PCAT attenuation in patients with type 2 diabetes mellitus (T2DM). METHODS: ) who underwent clinically indicated coronary CTA and examined their CT findings, coronary artery calcium score, pericardial fat volume, stenosis (> 50% luminal narrowing), high-risk plaque features of low-attenuation plaque and/or positive remodelling and/or spotty calcification, and PCAT attenuation. We assessed PCAT attenuation in Hounsfield units (HU) of proximal 40-mm segments of the left anterior descending artery (LAD) and right coronary artery (RCA). Cardiovascular events were defined as cardiac death, hospitalisation for acute coronary syndrome, late coronary revascularisation, and hospitalisation for heart failure. RESULTS: During a median follow-up of 4.0 years, we observed 31 cardiovascular events. LAD-PCAT attenuation was significantly higher in patients with cardiovascular events than in those without (- 68.5 ± 6.5 HU vs - 70.8 ± 6.1 HU, p = 0.045), whereas RCA-PCAT attenuation was not (p = 0.089). High LAD-PCAT attenuation (> - 70.7 HU; median value) was significantly associated with cardiovascular events in a model that included adverse CTA findings, such as significant stenosis and/or high-risk plaque (hazard ratio; 2.69, 95% confidence interval; 1.17-0.20, p = 0.020). After adding LAD-PCAT attenuation to the adverse CTA findings, the C-statistic and global chi-square values increased significantly from 0.65 to 0.70 (p = 0.037) and 10.9-15.0 (p = 0.043), respectively. CONCLUSIONS: In T2DM patients undergoing clinically indicated coronary CTA, high LAD-PCAT attenuation could significantly predict cardiovascular events. This suggests that assessing LAD-PCAT attenuation can help physicians identify high-risk T2DM patients.

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