Cardiometabolic predictors of high-risk CCTA phenotype in a diverse patient population

Epicardial adipose tissue, cardiac damage, and mortality in patients undergoing TAVR for aortic stenosis

Computed tomography (CT)-derived Epicardial Adipose Tissue (EAT) is linked to cardiovascular disease outcomes. However, its role in patients undergoing Transcatheter Aortic Valve Replacement (TAVR) and the interplay with aortic stenosis (AS) cardiac damage (CD) remains unexplored. We aim to investigate the relationship between EAT characteristics, AS CD, and all-cause mortality. We retrospectively included consecutive patients who underwent CT-TAVR followed by TAVR. EAT volume and density were estimated using a deep-learning platform and CD was assessed using echocardiography. Patients were classified according to low/high EAT volume and density. All-cause mortality at 4 years was compared using Kaplan-Meier and Cox regression analyses. A total of 666 patients (median age 81 [74-86] years; 54% female) were included. After a median follow-up of 1.28 (IQR 0.53-2.57) years, 11.7% (n = 77) of patients died. The EAT volume (p = 0.017) decreased, and density increased (p < 0.001) with worsening AS CD. Patients with low EAT volume (< 49cm3) and high density (≥-86 HU) had higher all-cause mortality (log-rank p = 0.02 and p = 0.01, respectively), even when adjusted for age, sex, and clinical characteristics (HR 1.71, p = 0.02 and HR 1.73, p = 0.03, respectively). When CD was added to the model, low EAT volume (HR 1.67 p = 0.03) and CD stages 3 and 4 (HR 3.14, p = 0.03) remained associated with all-cause mortality. In patients with AS undergoing TAVR, CT-derived low EAT volume, and high density were independently associated with increased 4-year mortality and worse CD stage. Only EAT volume remained associated when adjusted for CD.

Correlation Between Fat Attenuation Index and Plaque Parameters in Coronary CT Angiography: An Observational Study in Stable Coronary Artery Disease

BackgroundThe purpose of this prospective observational study was to predict plaque vulnerability, stenosis, and hemodynamic problems based on coronary CT angiography (CCTA) using the Fat Attenuation Index (FAI) as a marker.MethodsPatients with stable coronary artery disease (CAD) who underwent CCTA between January 2021 and January 2023 were included in this study. Data on basic patient information, plaque parameters, and Fractional Flow Reserve (FFR) were collected and analyzed. Multiple linear analysis was performed to explore the association between FAI and FFR. Additionally, regression models were developed to predict dependent variables such as FFR, plaque vulnerability, and the degree of stenosis based on FAI values. We also explored specific thresholds of FAI to classify plaques into vulnerable and non-vulnerable categories.ResultsA total of 62 patients with 84 coronary arteries were included in the final analysis. Based on FAI levels, the study subjects were divided into FAI-negative group (FAI ≤ -70.1 HU, 52 cases) and FAI-positive group (FAI > -70.1 HU, 32 cases). Patients in the FAI-positive group had significantly lower FFR values compared to those in the FAI-negative group, and the proportion of vulnerable plaques was significantly higher in the FAI-positive group. Furthermore, as the degree of stenosis observed on CCTA increased, FAI values showed a significant increase. Analysis of plaque types revealed that FAI in vulnerable plaques was significantly higher than in other plaque types. In the multiple linear analysis, lesion length, TPB and FFR was negatively correlated with FAI (β = -0.25, -0.13 and -41.72).ConclusionThe results support the use of FAI as a valuable tool in clinical practice. Its predictive capabilities regarding hemodynamic dysfunction and plaque susceptibility make it an essential component of modern cardiovascular risk assessment strategies.

The Role of Epicardial Adipose Tissue in Acute Coronary Syndromes, Post-Infarct Remodeling and Cardiac Regeneration

Epicardial adipose tissue (EAT) is a fat deposit surrounding the heart and located under the visceral layer of the pericardium. Due to its unique features, the contribution of EAT to the pathogenesis of cardiovascular and metabolic disorders is extensively studied. Especially, EAT can be associated with the onset and development of coronary artery disease, myocardial infarction and post-infarct heart failure which all are significant problems for public health. In this article, we focus on the mechanisms of how EAT impacts acute coronary syndromes. Particular emphasis was placed on the role of inflammation and adipokines secreted by EAT. Moreover, we present how EAT affects the remodeling of the heart following myocardial infarction. We further review the role of EAT as a source of stem cells for cardiac regeneration. In addition, we describe the imaging assessment of EAT, its prognostic value, and its correlation with the clinical characteristics of patients.