17 Aug 21. Featured Paper

Pericoronary & periaortic adipose tissue density are associated with inflammatory disease activity in Takayasu arteritis & atherosclerosis

Link to paper on European Heart Journal Open

Authors

Christopher Wall, Yuan Huang, Elizabeth P V Le, Andrej Ćorović, Christopher P Uy, Deepa Gopalan, Chuoxin Ma, Roido Manavaki, Tim D Fryer, Luigi Aloj, Martin J Graves, Enrico Tombetti, Ben Ariff, Paul Bambrough, Stephen P Hoole, Rosemary A Rusk, David R Jayne, Marc R Dweck, David Newby, Zahi A Fayad, Martin R Bennett, James E Peters, Piotr Slomka, Damini Dey, Justin C Mason, James H F Rudd, Jason M Tarkin

Abstract

Aims: To examine pericoronary (PCAT) & periaortic (PAAT) adipose tissue density on coronary computed tomography angiography (CCTA) for assessing arterial inflammation in Takayasu arteritis (TAK) & atherosclerosis.

Methods & results: PCAT & PAAT density was measured in coronary (n = 1016) & aortic (n = 108) segments from 108 subjects (TAK+coronary artery disease (CAD), n = 36; TAK, n = 18; atherosclerotic CAD, n = 32; matched controls, n = 22).

Median PCAT & PAAT densities varied between groups (mPCAT: p < 0.0001; PAAT: p = 0.0002).

PCAT density was 7.01 ± SEM 1.78 Hounsfield Unit (HU) higher in coronary segments from TAK+CAD patients than stable CAD patients (p = 0.0002), & 8.20 ± SEM 2.04 HU higher in TAK patients without CAD than controls (p = 0.0001).

mPCAT density was correlated with Indian Takayasu Clinical Activity Score (r = 0.43, p = 0.001) & C-reactive protein (r = 0.41, p < 0.0001), & was higher in active versus inactive TAK (p = 0.002).

mPCAT density above -74 HU had 100% sensitivity & 95% specificity for differentiating active TAK from controls (AUC=0.99 [95% CI 0.97-1]).

The association of PCAT density & coronary arterial inflammation measured by 68Ga-DOTATATE positron emission tomography equated to an increase of 2.44 ± SEM 0.77 HU in PCAT density for each unit increase in 68Ga-DOTATATE maximum tissue-to-blood ratio (p = 0.002).

These findings remained in multivariable sensitivity analyses adjusted for potential confounders.

Conclusions: PCAT & PAAT density are higher in TAK than atherosclerotic CAD or controls, & are associated with clinical, biochemical & PET markers of inflammation.

Owing to excellent diagnostic accuracy, PCAT density could be useful as a clinical adjunct for assessing disease activity in TAK.

Keywords

• Coronary artery disease

• Pericoronary adipose tissue density

• Takayasu arteritis