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Relationship between impaired myocardial blood flow by positron emission tomography and low-attenuation plaque burden and pericoronary adipose tissue attenuation from coronary computed tomography: From the prospective PACIFIC trial

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Positron emission tomography (PET) is the clinical gold standard for quantifying myocardial blood flow (MBF). Pericoronary adipose tissue (PCAT) attenuation may detect vascular inflammation indirectly. We examined the relationship between MBF by PET and plaque burden and PCAT on coronary CT angiography (CCTA).

Methods

This post hoc analysis of the PACIFIC trial included 208 patients with suspected coronary artery disease (CAD) who underwent [15O]H2O PET and CCTA. Low-attenuation plaque (LAP, < 30HU), non-calcified plaque (NCP), and PCAT attenuation were measured by CCTA.

Results

In 582 vessels, 211 (36.3%) had impaired per-vessel hyperemic MBF (≤ 2.30 mL/min/g). In multivariable analysis, LAP burden was independently and consistently associated with impaired hyperemic MBF (P = 0.016); over NCP burden (P = 0.997). Addition of LAP burden improved predictive performance for impaired hyperemic MBF from a model with CAD severity and calcified plaque burden (P < 0.001). There was no correlation between PCAT attenuation and hyperemic MBF (r = − 0.11), and PCAT attenuation was not associated with impaired hyperemic MBF in univariable or multivariable analysis of all vessels (P > 0.1).

Conclusion

In patients with stable CAD, LAP burden was independently associated with impaired hyperemic MBF and a stronger predictor of impaired hyperemic MBF than NCP burden. There was no association between PCAT attenuation and hyperemic MBF.

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Abbreviations

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

LAP:

Low-attenuation plaque

MBF:

Myocardial blood flow

NCP:

Non-calcified plaque

PCAT:

Pericoronary adipose tissue

PET:

Positron emission tomography

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Acknowledgements

This work was supported in part by grants from the National Heart, Lung, and Blood Institute, United States 1R01HL148787-01A1 and 1R01HL151266. This work was also supported by a grant from the Dr Miriam and Sheldon G. Adelson Medical Research Foundation. K.K. receives funding support from the Society of Nuclear Medicine and Molecular Imaging Wagner-Torizuka Fellowship grant and the Nihon University School of Medicine Alumni Association Research Grant. E.T. (FS/CRTF/20/24086) is supported by the British Heart Foundation.

Disclosures

Outside of the current work, S.C., P.S., and D.D. received software royalties from Cedars-Sinai Medical Center. D.B, P.S., and D.D. hold a patent (US8885905B2 in USA and WO patent WO2011069120A1, Method and System for Plaque Characterization). P.K. has received research grants from HeartFlow Inc.

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Author notes

  1. Damini Dey and Paul Knaapen have contributed equally as senior authors.

Authors and Affiliations

  1. Department of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Keiichiro Kuronuma MD, PhD, Donghee Han MD, Alan Kwan MD, Eyal Klein MD, Balaji Tamarappoo MD, PhD & Daniel S. Berman MD

  2. Department of Cardiology, Nihon University, Tokyo, Japan

    Keiichiro Kuronuma MD, PhD

  3. Department of Cardiology, Amsterdam UMC, VUmc, Amsterdam, The Netherlands

    Pepijn A. van Diemen MD, Ibrahim Danad MD, Roel S. Driessen MD & Paul Knaapen MD, PhD

  4. Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Boulevard, Los Angeles, CA, 90048, USA

    Andrew Lin MBBS, PhD, Kajetan Grodecki MD, Priscilla McElhinney BSc, Guadalupe Flores Tomasino MD, Caroline Park BSc, Benjamin Shou BSc, Sebastien Cadet MSc & Damini Dey PhD

  5. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland

    Jacek Kwiecinski MD, PhD

  6. Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK

    Manish Motwani MBChB, PhD

  7. BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK

    Evangelos Tzolos MD

  8. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Piotr J. Slomka PhD

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Correspondence to Damini Dey PhD.

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Kuronuma, K., van Diemen, P.A., Han, D. et al. Relationship between impaired myocardial blood flow by positron emission tomography and low-attenuation plaque burden and pericoronary adipose tissue attenuation from coronary computed tomography: From the prospective PACIFIC trial. J. Nucl. Cardiol. 30, 1558–1569 (2023). https://doi.org/10.1007/s12350-022-03194-z

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