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Publications

Journal Article Ahead of print 1 citation

PubMed: 42900033 DOI: 10.1016/j.jcmg.2026.08.018

Patient-Level Perivascular Adipose Tissue Density Aggregation and Plaque Progression: Plaque-Free vs Plaque-Adjacent Segments.

JACC Cardiovasc Imaging

Authors: Sang-Eun Lee, Ji Min Sung, Daniele Andreini, Mouaz H Al-Mallah, Matthew J Budoff, Filippo Cademartiri, Kavitha Chinnaiyan, Jung Hyun Choi, Eun Ju Chun, Edoardo Conte, Ilan Gottlieb, Martin Hadamitzky, Yong Jin Kim, Byoung Kwon Lee, Jonathon A Leipsic, Erica Maffei, Hugo Marques, Pedro de Araújo Gonçalves, Gianluca Pontone, Peter H Stone, Renu Virmani, Jagat Narula, Leslee J Shaw, Jeroen J Bax, Fay Y Lin, James K Min, Hyuk-Jae Chang

Affiliations

  • Division of Cardiology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.
  • CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea.
  • IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
  • Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.
  • Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, California, USA.
  • Department of Radiology, IRCCS SYNLAB SDN, Naples, Italy.
  • Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA.
  • Pusan University Hospital, Busan, South Korea.
  • Seoul National University Bundang Hospital, Seongnam, South Korea.
  • Department of Clinical and Imaging Cardiology-Galeazzi-Sant'Ambrogio Hospital, Milan, Italy.
  • Department of Radiology, Fonte Imagem Medicina Diagnostica, Rio de Janeiro, Brazil.
  • Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.
  • Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
  • Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
  • Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
  • UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal.
  • UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal; Comprehensive Health Research Center (CHRC), LA-REAL, NOVA Medical School, Campo Mártires da Pátria, Lisboa, Portugal.
  • Department of Biomedical, Dental and Surgical Sciences, University of Milan, Milan, Italy; Centro Cardiologico Monzino IRCCS, Milan, Italy.
  • Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Department of Pathology, CVPath Institute, Gaithersburg, Maryland, USA.
  • University of Texas Health Houston, Houston, Texas, USA.
  • Icahn School of Medicine at Mount Sinai, New York, New York, USA.
  • Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
  • Cleerly, Inc, New York, New York, USA.
  • CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.

Abstract

BACKGROUND

Perivascular adipose tissue (PVAT) density on coronary computed tomography angiography (CTA) reflects pericoronary inflammation, but measurements adjacent to existing plaques may be confounded by local inflammatory signaling from the plaque itself-a form of reverse causation. Whether systematically comparing patient-level PVAT aggregation approaches (including measurements restricted to plaque-free segments) can identify a more robust inflammatory biomarker has not been evaluated.

OBJECTIVES

The authors aimed to compare the predictive performance of 4 patient-level PVAT aggregation approaches for coronary plaque progression.

METHODS

From the PARADIGM serial coronary CTA registry, 412 patients with baseline coronary plaque who underwent serial coronary CTA at identical tube voltages were included (mean age: 61.1 ± 9.3 years; 61.7% male; mean interval: 3.2 ± 1.2 years). Four patient-level PVAT measures were compared: proximal right coronary artery (pRCA), whole-coronary, plaque-free, and plaque PVAT. Multivariable regression models were constructed for annualized plaque volume (PV) progression with adjustment for clinical risk factors and imaging covariates.

RESULTS

Annualized increases in pRCA PVAT (β = 0.804; P = 0.033), whole-coronary PVAT (β = 1.142; P = 0.022), and plaque-free PVAT (β = 1.419; P = 0.007) were each independently associated with total PV progression, whereas plaque PVAT did not reach significance (β = 0.755; P = 0.083). For noncalcified PV progression, plaque-free PVAT was the only significant measure (β = 1.086; P = 0.026). None of the 4 baseline PVAT measures were significantly associated with plaque progression (all P > 0.50). Pairwise comparisons revealed no significant differences among the 4 measures.

CONCLUSIONS

Changes in pRCA, whole-coronary, and plaque-free PVAT were each independently associated with total PV progression. For noncalcified PV progression, plaque-free PVAT change was the only significant measure. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411).

MeSH

Research Design, Coronary Artery Disease, Tissues, Adipose Tissue