Pericoronary Adipose Tissue Attenuation, Low-Attenuation Plaque Burden, and 5-Year Risk of Myocardial Infarction

Evangelos Tzolos; Michelle C. Williams; Priscilla McElhinney; Andrew Lin; Kajetan Grodecki; Guadalupe Flores Tomasino; Sebastien Cadet; Jacek Kwiecinski; Mhairi Doris; Philip D. Adamson; Alastair J. Moss; Shirjel Alam; Amanda Hunter; Anoop S. V. Shah; Nicholas L. Mills; Tania Pawade; Chengjia Wang; Jonathan R. Weir-McCall; Giles Roditi; Edwin J. R. van Beek; Leslee J. Shaw; Edward D. Nicol; Daniel S. Berman; Piotr J. Slomka; Marc R. Dweck; David E. Newby; Damini Dey

doi:10.1016/j.jcmg.2022.02.004

Pericoronary Adipose Tissue Attenuation, Low-Attenuation Plaque Burden, and 5-Year Risk of Myocardial Infarction

Evangelos Tzolos
, Michelle C. Williams
, Priscilla McElhinney
, Andrew Lin
, Kajetan Grodecki
, Guadalupe Flores Tomasino
, Sebastien Cadet
, Jacek Kwiecinski
, Mhairi Doris
, Philip D. Adamson
, Alastair J. Moss
, Shirjel Alam
, Amanda Hunter
, Anoop S. V. Shah
, Nicholas L. Mills
, Tania Pawade
, Chengjia Wang
, Jonathan R. Weir-McCall
, Giles Roditi
, Edwin J. R. van Beek

Leslee J. Shaw, Edward D. Nicol, Daniel S. Berman, Piotr J. Slomka, Marc R. Dweck, David E. Newby, Damini Dey^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

150 Citations (Scopus)

Abstract

Background
Pericoronary adipose tissue (PCAT) attenuation and low-attenuation noncalcified plaque (LAP) burden can both predict outcomes.

Objectives
This study sought to assess the relative and additive values of PCAT attenuation and LAP to predict future risk of myocardial infarction.

Methods
In a post hoc analysis of the multicenter SCOT-HEART (Scottish Computed Tomography of the Heart) trial, the authors investigated the relationships between the future risk of fatal or nonfatal myocardial infarction and PCAT attenuation measured from coronary computed tomography angiography (CTA) using multivariable Cox regression models including plaque burden, obstructive coronary disease, and cardiac risk score (incorporating age, sex, diabetes, smoking, hypertension, hyperlipidemia, and family history).

Results
In 1,697 evaluable participants (age: 58 ± 10 years), there were 37 myocardial infarctions after a median follow-up of 4.7 years. Mean PCAT was −76 ± 8 HU and median LAP burden was 4.20% (IQR: 0%-6.86%). PCAT attenuation of the right coronary artery (RCA) was predictive of myocardial infarction (HR: 1.55; P = 0.017, per 1 SD increment) with an optimum threshold of −70.5 HU (HR: 2.45; P = 0.01). In multivariable analysis, adding PCAT-RCA of ≥−70.5 HU to an LAP burden of >4% (the optimum threshold for future myocardial infarction; HR: 4.87; P < 0.0001) led to improved prediction of future myocardial infarction (HR: 11.7; P < 0.0001). LAP burden showed higher area under the curve compared to PCAT attenuation for the prediction of myocardial infarction (AUC = 0.71 [95% CI: 0.62-0.80] vs AUC = 0.64 [95% CI: 0.54-0.74]; P < 0.001), with increased area under the curve when the 2 metrics are combined (AUC = 0.75 [95% CI: 0.65-0.85]; P = 0.037).

Conclusion
Coronary CTA–defined LAP burden and PCAT attenuation have marked and complementary predictive value for the risk of fatal or nonfatal myocardial infarction.

Original language	English
Pages (from-to)	1078-1088
Number of pages	11
Journal	JACC: Cardiovascular Imaging
Volume	15
Issue number	6
Early online date	13 Apr 2022
DOIs	https://doi.org/10.1016/j.jcmg.2022.02.004
Publication status	Published - 1 Jun 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

computed tomography angiography
coronary artery disease
low-attenuation noncalcified plaque burden
noncalcified plaque burden
pericoronary adipose tissue
risk stratification

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.jcmg.2022.02.004

Cite this

Tzolos, E., Williams, M. C., McElhinney, P., Lin, A., Grodecki, K., Flores Tomasino, G., Cadet, S., Kwiecinski, J., Doris, M., Adamson, P. D., Moss, A. J., Alam, S., Hunter, A., Shah, A. S. V., Mills, N. L., Pawade, T., Wang, C., Weir-McCall, J. R., Roditi, G., ... Dey, D. (2022). Pericoronary Adipose Tissue Attenuation, Low-Attenuation Plaque Burden, and 5-Year Risk of Myocardial Infarction. JACC: Cardiovascular Imaging, 15(6), 1078-1088. https://doi.org/10.1016/j.jcmg.2022.02.004

@article{f544efdb0c4b48aa9e8c21621fb0aa54,

title = "Pericoronary Adipose Tissue Attenuation, Low-Attenuation Plaque Burden, and 5-Year Risk of Myocardial Infarction",

abstract = "Background Pericoronary adipose tissue (PCAT) attenuation and low-attenuation noncalcified plaque (LAP) burden can both predict outcomes. Objectives This study sought to assess the relative and additive values of PCAT attenuation and LAP to predict future risk of myocardial infarction. Methods In a post hoc analysis of the multicenter SCOT-HEART (Scottish Computed Tomography of the Heart) trial, the authors investigated the relationships between the future risk of fatal or nonfatal myocardial infarction and PCAT attenuation measured from coronary computed tomography angiography (CTA) using multivariable Cox regression models including plaque burden, obstructive coronary disease, and cardiac risk score (incorporating age, sex, diabetes, smoking, hypertension, hyperlipidemia, and family history). Results In 1,697 evaluable participants (age: 58 ± 10 years), there were 37 myocardial infarctions after a median follow-up of 4.7 years. Mean PCAT was −76 ± 8 HU and median LAP burden was 4.20\% (IQR: 0\%-6.86\%). PCAT attenuation of the right coronary artery (RCA) was predictive of myocardial infarction (HR: 1.55; P = 0.017, per 1 SD increment) with an optimum threshold of −70.5 HU (HR: 2.45; P = 0.01). In multivariable analysis, adding PCAT-RCA of ≥−70.5 HU to an LAP burden of >4\% (the optimum threshold for future myocardial infarction; HR: 4.87; P < 0.0001) led to improved prediction of future myocardial infarction (HR: 11.7; P < 0.0001). LAP burden showed higher area under the curve compared to PCAT attenuation for the prediction of myocardial infarction (AUC = 0.71 [95\% CI: 0.62-0.80] vs AUC = 0.64 [95\% CI: 0.54-0.74]; P < 0.001), with increased area under the curve when the 2 metrics are combined (AUC = 0.75 [95\% CI: 0.65-0.85]; P = 0.037). Conclusion Coronary CTA–defined LAP burden and PCAT attenuation have marked and complementary predictive value for the risk of fatal or nonfatal myocardial infarction.",

keywords = "computed tomography angiography, coronary artery disease, low-attenuation noncalcified plaque burden, noncalcified plaque burden, pericoronary adipose tissue, risk stratification",

author = "Evangelos Tzolos and Williams, \{Michelle C.\} and Priscilla McElhinney and Andrew Lin and Kajetan Grodecki and \{Flores Tomasino\}, Guadalupe and Sebastien Cadet and Jacek Kwiecinski and Mhairi Doris and Adamson, \{Philip D.\} and Moss, \{Alastair J.\} and Shirjel Alam and Amanda Hunter and Shah, \{Anoop S. V.\} and Mills, \{Nicholas L.\} and Tania Pawade and Chengjia Wang and Weir-McCall, \{Jonathan R.\} and Giles Roditi and \{van Beek\}, \{Edwin J. R.\} and Shaw, \{Leslee J.\} and Nicol, \{Edward D.\} and Berman, \{Daniel S.\} and Slomka, \{Piotr J.\} and Dweck, \{Marc R.\} and Newby, \{David E.\} and Damini Dey",

note = "Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",

year = "2022",

month = jun,

day = "1",

doi = "10.1016/j.jcmg.2022.02.004",

language = "English",

volume = "15",

pages = "1078--1088",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "6",

}

Tzolos, E, Williams, MC, McElhinney, P, Lin, A, Grodecki, K, Flores Tomasino, G, Cadet, S, Kwiecinski, J, Doris, M, Adamson, PD, Moss, AJ, Alam, S, Hunter, A, Shah, ASV, Mills, NL, Pawade, T, Wang, C, Weir-McCall, JR, Roditi, G, van Beek, EJR, Shaw, LJ, Nicol, ED, Berman, DS, Slomka, PJ, Dweck, MR, Newby, DE & Dey, D 2022, 'Pericoronary Adipose Tissue Attenuation, Low-Attenuation Plaque Burden, and 5-Year Risk of Myocardial Infarction', JACC: Cardiovascular Imaging, vol. 15, no. 6, pp. 1078-1088. https://doi.org/10.1016/j.jcmg.2022.02.004

TY - JOUR

T1 - Pericoronary Adipose Tissue Attenuation, Low-Attenuation Plaque Burden, and 5-Year Risk of Myocardial Infarction

AU - Tzolos, Evangelos

AU - Williams, Michelle C.

AU - McElhinney, Priscilla

AU - Lin, Andrew

AU - Grodecki, Kajetan

AU - Flores Tomasino, Guadalupe

AU - Cadet, Sebastien

AU - Kwiecinski, Jacek

AU - Doris, Mhairi

AU - Adamson, Philip D.

AU - Moss, Alastair J.

AU - Alam, Shirjel

AU - Hunter, Amanda

AU - Shah, Anoop S. V.

AU - Mills, Nicholas L.

AU - Pawade, Tania

AU - Wang, Chengjia

AU - Weir-McCall, Jonathan R.

AU - Roditi, Giles

AU - van Beek, Edwin J. R.

AU - Shaw, Leslee J.

AU - Nicol, Edward D.

AU - Berman, Daniel S.

AU - Slomka, Piotr J.

AU - Dweck, Marc R.

AU - Newby, David E.

AU - Dey, Damini

PY - 2022/6/1

Y1 - 2022/6/1

N2 - Background Pericoronary adipose tissue (PCAT) attenuation and low-attenuation noncalcified plaque (LAP) burden can both predict outcomes. Objectives This study sought to assess the relative and additive values of PCAT attenuation and LAP to predict future risk of myocardial infarction. Methods In a post hoc analysis of the multicenter SCOT-HEART (Scottish Computed Tomography of the Heart) trial, the authors investigated the relationships between the future risk of fatal or nonfatal myocardial infarction and PCAT attenuation measured from coronary computed tomography angiography (CTA) using multivariable Cox regression models including plaque burden, obstructive coronary disease, and cardiac risk score (incorporating age, sex, diabetes, smoking, hypertension, hyperlipidemia, and family history). Results In 1,697 evaluable participants (age: 58 ± 10 years), there were 37 myocardial infarctions after a median follow-up of 4.7 years. Mean PCAT was −76 ± 8 HU and median LAP burden was 4.20% (IQR: 0%-6.86%). PCAT attenuation of the right coronary artery (RCA) was predictive of myocardial infarction (HR: 1.55; P = 0.017, per 1 SD increment) with an optimum threshold of −70.5 HU (HR: 2.45; P = 0.01). In multivariable analysis, adding PCAT-RCA of ≥−70.5 HU to an LAP burden of >4% (the optimum threshold for future myocardial infarction; HR: 4.87; P < 0.0001) led to improved prediction of future myocardial infarction (HR: 11.7; P < 0.0001). LAP burden showed higher area under the curve compared to PCAT attenuation for the prediction of myocardial infarction (AUC = 0.71 [95% CI: 0.62-0.80] vs AUC = 0.64 [95% CI: 0.54-0.74]; P < 0.001), with increased area under the curve when the 2 metrics are combined (AUC = 0.75 [95% CI: 0.65-0.85]; P = 0.037). Conclusion Coronary CTA–defined LAP burden and PCAT attenuation have marked and complementary predictive value for the risk of fatal or nonfatal myocardial infarction.

AB - Background Pericoronary adipose tissue (PCAT) attenuation and low-attenuation noncalcified plaque (LAP) burden can both predict outcomes. Objectives This study sought to assess the relative and additive values of PCAT attenuation and LAP to predict future risk of myocardial infarction. Methods In a post hoc analysis of the multicenter SCOT-HEART (Scottish Computed Tomography of the Heart) trial, the authors investigated the relationships between the future risk of fatal or nonfatal myocardial infarction and PCAT attenuation measured from coronary computed tomography angiography (CTA) using multivariable Cox regression models including plaque burden, obstructive coronary disease, and cardiac risk score (incorporating age, sex, diabetes, smoking, hypertension, hyperlipidemia, and family history). Results In 1,697 evaluable participants (age: 58 ± 10 years), there were 37 myocardial infarctions after a median follow-up of 4.7 years. Mean PCAT was −76 ± 8 HU and median LAP burden was 4.20% (IQR: 0%-6.86%). PCAT attenuation of the right coronary artery (RCA) was predictive of myocardial infarction (HR: 1.55; P = 0.017, per 1 SD increment) with an optimum threshold of −70.5 HU (HR: 2.45; P = 0.01). In multivariable analysis, adding PCAT-RCA of ≥−70.5 HU to an LAP burden of >4% (the optimum threshold for future myocardial infarction; HR: 4.87; P < 0.0001) led to improved prediction of future myocardial infarction (HR: 11.7; P < 0.0001). LAP burden showed higher area under the curve compared to PCAT attenuation for the prediction of myocardial infarction (AUC = 0.71 [95% CI: 0.62-0.80] vs AUC = 0.64 [95% CI: 0.54-0.74]; P < 0.001), with increased area under the curve when the 2 metrics are combined (AUC = 0.75 [95% CI: 0.65-0.85]; P = 0.037). Conclusion Coronary CTA–defined LAP burden and PCAT attenuation have marked and complementary predictive value for the risk of fatal or nonfatal myocardial infarction.

KW - computed tomography angiography

KW - coronary artery disease

KW - low-attenuation noncalcified plaque burden

KW - noncalcified plaque burden

KW - pericoronary adipose tissue

KW - risk stratification

UR - https://www.scopus.com/pages/publications/85130913379

U2 - 10.1016/j.jcmg.2022.02.004

DO - 10.1016/j.jcmg.2022.02.004

M3 - Article

C2 - 35450813

AN - SCOPUS:85130913379

SN - 1936-878X

VL - 15

SP - 1078

EP - 1088

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 6

ER -

Pericoronary Adipose Tissue Attenuation, Low-Attenuation Plaque Burden, and 5-Year Risk of Myocardial Infarction

Abstract

UN SDGs

Keywords

ASJC Scopus subject areas

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