Top

Published in:

01-07-2017 | Original Article

Pericoronary adipose tissue ratio is a stronger associated factor of plaque vulnerability than epicardial adipose tissue on coronary computed tomography angiography

Authors: Ryo Okubo, Rine Nakanishi, Mikihito Toda, Daiga Saito, Ippei Watanabe, Takayuki Yabe, Hideo Amano, Tatsushi Hirai, Takanori Ikeda

Published in: Heart and Vessels | Issue 7/2017

Abstract

This study was designed to clarify the influence of pericoronary adipose tissue (PAT) on plaque vulnerability using coronary computed tomography angiography (CCTA). A total of 103 consecutive patients who underwent CCTA and subsequent percutaneous coronary intervention (PCI) using intravascular ultrasound (IVUS) for coronary artery disease were enrolled. The PAT ratio was calculated as the sum of the perpendicular thickness of the visceral layer between the coronary artery and the pericardium, or the coronary artery and the surface of the heart at the PCI site, divided by the PAT thickness without a plaque in the same vessel. PAT ratios were divided into low, mid and high tertile groups. Epicardial adipose tissue (EAT) thickness was measured at the eight points surrounding the heart. Multivariate logistic analysis was performed to determine whether the PAT ratio is predictive of vulnerable plaques (positive remodeling, low attenuation and/or spotty calcification) on CCTA or echo-attenuated plaque on IVUS. The Hounsfield unit of obstructive plaques >50% was lower in the high PAT group than in the mid and low PAT groups (47.5 ± 28.8 vs. 53.1 ± 29.7 vs. 64.7 ± 27.0, p = 0.04). In multivariate logistic analysis, a high PAT ratio was an independent, associated factor of vulnerable plaques on CCTA (OR: 3.55, 95% CI: 1.20–10.49), whereas mean EAT thickness was not (OR: 1.22, 95% CI: 0.82–1.83). We observed a similar result in predicting echo-attenuated plaque on IVUS. PAT ratio on CCTA was an associated factor of vulnerable plaques, while EAT was not. These results support the important concept of local effects of cardiac adipose tissue on plaque vulnerability.

Bettencourt N, Toschke AM, Leite D, Rocha J, Carvalho M, Sampaio F, Xara S, Leite-Moreira A, Nagel E, Gama V (2012) Epicardial adipose tissue is an independent predictor of coronary atherosclerotic burden. Int J Cardiol 158:26–32CrossRefPubMed

Alexopoulos N, McLean DS, Janik M, Arepalli CD, Stillman AE, Raggi P (2010) Epicardial adipose tissue and coronary artery plaque characteristics. Atherosclerosis 210:150–154CrossRefPubMed

Nakanishi R, Rajani R, Cheng VY, Gransar H, Nakazato R, Shmilovich H, Otaki Y, Hayes SW, Thomson LE, Friedman JD, Slomka PJ, Berman DS, Dey D (2011) Increase in epicardial fat volume is associated with greater coronary artery calcification progression in subjects at intermediate risk by coronary calcium score: a serial study using non-contrast cardiac CT. Atherosclerosis 218:363–368CrossRefPubMed

Sarin S, Wenger C, Marwaha A, Qureshi A, Go BD, Woomert CA, Clark K, Nassef LA, Shirani J (2008) Clinical significance of epicardial fat measured using cardiac multislice computed tomography. Am J Cardiol 102:767–771CrossRefPubMed

Mahabadi AA, Massaro JM, Rosito GA, Levy D, Murabito JM, Wolf PA, O’Donnell CJ, Fox CS, Hoffmann U (2009) Association of pericardial fat, intrathoracic fat, and visceral abdominal fat with cardiovascular disease burden: the Framingham Heart Study. Eur Heart J 30:850–856CrossRefPubMedPubMedCentral

Harada K, Amano T, Uetani T, Tokuda Y, Kitagawa K, Shimbo Y, Kunimura A, Kumagai S, Yoshida T, Kato B, Kato M, Marui N, Ishii H, Matsubara T, Murohara T (2011) Cardiac 64-multislice computed tomography reveals increased epicardial fat volume in patients with acute coronary syndrome. Am J Cardiol 108:1119–1123CrossRefPubMed

Hajsadeghi F, Nabavi V, Bhandari A, Choi A, Vincent H, Flores F, Budoff M, Ahmadi N (2014) Increased epicardial adipose tissue is associated with coronary artery disease and major adverse cardiovascular events. Atherosclerosis 237:486–489CrossRefPubMed

Yamashita K, Yamamoto MH, Ebara S, Okabe T, Saito S, Hoshimoto K, Yakushiji T, Isomura N, Araki H, Obara C, Ochiai M (2014) Association between increased epicardial adipose tissue volume and coronary plaque composition. Heart Vessels 29:569–577CrossRefPubMed

Maurovich-Horvat P, Kallianos K, Engel LC, Szymonifka J, Fox CS, Hoffmann U, Truong QA (2011) Influence of pericoronary adipose tissue on local coronary atherosclerosis as assessed by a novel MDCT volumetric method. Atherosclerosis 219:151–157CrossRefPubMedPubMedCentral

10.

Mahabadi AA, Reinsch N, Lehmann N, Altenbernd J, Kalsch H, Seibel RM, Erbel R, Mohlenkamp S (2010) Association of pericoronary fat volume with atherosclerotic plaque burden in the underlying coronary artery: a segment analysis. Atherosclerosis 211:195–199CrossRefPubMed

11.

Gorter PM, van Lindert AS, de Vos AM, Meijs MF, van der Graaf Y, Doevendans PA, Prokop M, Visseren FL (2008) Quantification of epicardial and peri-coronary fat using cardiac computed tomography; reproducibility and relation with obesity and metabolic syndrome in patients suspected of coronary artery disease. Atherosclerosis 197:896–903CrossRefPubMed

12.

Steigner ML, Mitsouras D, Whitmore AG, Otero HJ, Wang C, Buckley O, Levit NA, Hussain AZ, Cai T, Mather RT, Smedby O, DiCarli MF, Rybicki FJ (2010) Iodinated contrast opacification gradients in normal coronary arteries imaged with prospectively ECG-gated single heart beat 320-detector row computed tomography. Circ Cardiovasc Imaging 3:179–186CrossRefPubMed

13.

Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T, Inoue K, Okumura M, Ishii J, Anno H, Virmani R, Ozaki Y, Hishida H, Narula J (2007) Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 50:319–326CrossRefPubMed

14.

Kitagawa T, Yamamoto H, Horiguchi J, Ohhashi N, Tadehara F, Shokawa T, Dohi Y, Kunita E, Utsunomiya H, Kohno N, Kihara Y (2009) Characterization of noncalcified coronary plaques and identification of culprit lesions in patients with acute coronary syndrome by 64-slice computed tomography. JACC Cardiovasc Imaging 2:153–160CrossRefPubMed

15.

Motoyama S, Sarai M, Harigaya H, Anno H, Inoue K, Hara T, Naruse H, Ishii J, Hishida H, Wong ND, Virmani R, Kondo T, Ozaki Y, Narula J (2009) Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 54:49–57CrossRefPubMed

16.

Motoyama S, Ito H, Sarai M, Kondo T, Kawai H, Nagahara Y, Harigaya H, Kan S, Anno H, Takahashi H, Naruse H, Ishii J, Hecht H, Shaw LJ, Ozaki Y, Narula J (2015) Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol 66:337–346CrossRefPubMed

17.

Otsuka K, Fukuda S, Tanaka A, Nakanishi K, Taguchi H, Yoshikawa J, Shimada K, Yoshiyama M (2013) Napkin-ring sign on coronary CT angiography for the prediction of acute coronary syndrome. JACC Cardiovasc Imaging 6:448–457CrossRefPubMed

18.

Watabe H, Sato A, Akiyama D, Kakefuda Y, Adachi T, Ojima E, Hoshi T, Murakoshi N, Ishizu T, Seo Y, Aonuma K (2012) Impact of coronary plaque composition on cardiac troponin elevation after percutaneous coronary intervention in stable angina pectoris: a computed tomography analysis. J Am Coll Cardiol 59:1881–1888CrossRefPubMed

19.

Nakazawa G, Tanabe K, Onuma Y, Yachi S, Aoki J, Yamamoto H, Higashikuni Y, Yagishita A, Nakajima H, Hara K (2008) Efficacy of culprit plaque assessment by 64-slice multidetector computed tomography to predict transient no-reflow phenomenon during percutaneous coronary intervention. Am Heart J 155:1150–1157CrossRefPubMed

20.

Tamaru H, Fujii K, Fukunaga M, Imanaka T, Miki K, Horimatsu T, Nishimura M, Saita T, Sumiyoshi A, Shibuya M, Naito Y, Masuyama T (2016) Impact of spotty calcification on long-term prediction of future revascularization: a prospective three-vessel intravascular ultrasound study. Heart Vessels 31:881–889CrossRefPubMed

21.

Achenbach S, Ropers D, Hoffmann U, MacNeill B, Baum U, Pohle K, Brady TJ, Pomerantsev E, Ludwig J, Flachskampf FA, Wicky S, Jang IK, Daniel WG (2004) Assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol 43:842–847CrossRefPubMed

22.

Achenbach S, Moselewski F, Ropers D, Ferencik M, Hoffmann U, MacNeill B, Pohle K, Baum U, Anders K, Jang IK, Daniel WG, Brady TJ (2004) Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography: a segment-based comparison with intravascular ultrasound. Circulation 109:14–17CrossRefPubMed

23.

Kroner ES, van Velzen JE, Boogers MJ, Siebelink HM, Schalij MJ, Kroft LJ, de Roos A, van der Wall EE, Jukema JW, Reiber JH, Schuijf JD, Bax JJ (2011) Positive remodeling on coronary computed tomography as a marker for plaque vulnerability on virtual histology intravascular ultrasound. Am J Cardiol 107:1725–1729CrossRefPubMed

24.

Kashiwagi M, Tanaka A, Kitabata H, Tsujioka H, Kataiwa H, Komukai K, Tanimoto T, Takemoto K, Takarada S, Kubo T, Hirata K, Nakamura N, Mizukoshi M, Imanishi T, Akasaka T (2009) Feasibility of noninvasive assessment of thin-cap fibroatheroma by multidetector computed tomography. JACC Cardiovasc Imaging 2:1412–1419CrossRefPubMed

25.

Ito T, Terashima M, Kaneda H, Nasu K, Matsuo H, Ehara M, Kinoshita Y, Kimura M, Tanaka N, Habara M, Katoh O, Suzuki T (2011) Comparison of in vivo assessment of vulnerable plaque by 64-slice multislice computed tomography versus optical coherence tomography. Am J Cardiol 107:1270–1277CrossRefPubMed

26.

Leipsic J, Abbara S, Achenbach S, Cury R, Earls JP, Mancini GJ, Nieman K, Pontone G, Raff GL (2014) SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 8:342–358CrossRefPubMed

27.

Shmilovich H, Cheng VY, Tamarappoo BK, Dey D, Nakazato R, Gransar H, Thomson LE, Hayes SW, Friedman JD, Germano G, Slomka PJ, Berman DS (2011) Vulnerable plaque features on coronary CT angiography as markers of inducible regional myocardial hypoperfusion from severe coronary artery stenoses. Atherosclerosis 219:588–595CrossRefPubMedPubMedCentral

28.

Schlett CL, Ferencik M, Kriegel MF, Bamberg F, Ghoshhajra BB, Joshi SB, Nagurney JT, Fox CS, Truong QA, Hoffmann U (2012) Association of pericardial fat and coronary high-risk lesions as determined by cardiac CT. Atherosclerosis 222:129–134CrossRefPubMedPubMedCentral

29.

Tanaka A, Shimada K, Yoshida K, Jissyo S, Tanaka H, Sakamoto M, Matsuba K, Imanishi T, Akasaka T, Yoshikawa J (2008) Non-invasive assessment of plaque rupture by 64-slice multidetector computed tomography-comparison with intravascular ultrasound. Circ J 72:1276–1281CrossRefPubMed

30.

Mintz GS, Nissen SE, Anderson WD, Bailey SR, Erbel R, Fitzgerald PJ, Pinto FJ, Rosenfield K, Siegel RJ, Tuzcu EM, Yock PG, American College of Cardiology (2001) Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 37:1478–1492CrossRefPubMed

31.

Kimura S, Kakuta T, Yonetsu T, Suzuki A, Iesaka Y, Fujiwara H, Isobe M (2009) Clinical significance of echo signal attenuation on intravascular ultrasound in patients with coronary artery disease. Circ Cardiovasc Interv 2:444–454CrossRefPubMed

32.

Wang TD, Lee WJ, Shih FY, Huang CH, Chang YC, Chen WJ, Lee YT, Chen MF (2009) Relations of epicardial adipose tissue measured by multidetector computed tomography to components of the metabolic syndrome are region-specific and independent of anthropometric indexes and intraabdominal visceral fat. J Clin Endocrinol Metab 94:662–669CrossRefPubMed

33.

Djaberi R, Schuijf JD, van Werkhoven JM, Nucifora G, Jukema JW, Bax JJ (2008) Relation of epicardial adipose tissue to coronary atherosclerosis. Am J Cardiol 102:1602–1607CrossRefPubMed

34.

Rajani R, Shmilovich H, Nakazato R, Nakanishi R, Otaki Y, Cheng VY, Hayes SW, Thomson LE, Friedman JD, Slomka PJ, Min JK, Berman DS, Dey D (2013) Relationship of epicardial fat volume to coronary plaque, severe coronary stenosis, and high-risk coronary plaque features assessed by coronary CT angiography. J Cardiovasc Comput Tomogr 7:125–132CrossRefPubMedPubMedCentral

35.

Tachibana M, Miyoshi T, Osawa K, Toh N, Oe H, Nakamura K, Naito T, Sato S, Kanazawa S, Ito H (2016) Measurement of epicardial fat thickness by transthoracic echocardiography for predicting high-risk coronary artery plaques. Heart Vessels 31:1758–1766CrossRefPubMed

36.

Oikawa M, Owada T, Yamauchi H, Misaka T (2015) Epicardial adipose tissue reflects the presence of coronary artery disease: comparison with abdominal visceral adipose tissue. Biomed Res Int. doi:10.1155/2015/483982 PubMedPubMedCentral

37.

Harada K, Amano T, Kataoka T, Takeshita M, Harada K, Kunimura A, Takayama Y, Shinoda N, Kato B, Uetani T, Kato M, Marui N, Ishii H, Matsubara T, Murohara T (2014) Impact of abdominal and epicardial fat on the association between plasma adipocytokine levels and coronary atherosclerosis in non-obese patients. Atherosclerosis 237:671–676CrossRefPubMed

38.

Mazurek T, Zhang L, Zalewski A, Mannion JD, Diehl JT, Arafat H, Sarov-Blat L, O’Brien S, Keiper EA, Johnson AG, Martin J, Goldstein BJ, Shi Y (2003) Human epicardial adipose tissue is a source of inflammatory mediators. Circulation 108:2460–2466CrossRefPubMed

39.

Baker AR, Silva NF, Quinn DW, Harte AL, Pagano D, Bonser RS, Kumar S, McTernan PG (2006) Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease. Cardiovasc Diabetol 5:1CrossRefPubMedPubMedCentral

40.

Pou KM, Massaro JM, Hoffmann U, Vasan RS, Maurovich-Horvat P, Larson MG, Keaney JF Jr, Meigs JB, Lipinska I, Kathiresan S, Murabito JM, O’Donnell CJ, Benjamin EJ, Fox CS (2007) Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress: the Framingham Heart Study. Circulation 116:1234–1241CrossRefPubMed

41.

Hirata Y, Tabata M, Kurobe H, Motoki T, Akaike M, Nishio C, Higashida M, Mikasa H, Nakaya Y, Takanashi S, Igarashi T, Kitagawa T, Sata M (2011) Coronary atherosclerosis is associated with macrophage polarization in epicardial adipose tissue. J Am Coll Cardiol 58:248–255CrossRefPubMed

42.

Hirata Y, Kurobe H, Akaike M, Chikugo F, Hori T, Bando Y, Nishio C, Higashida M, Nakaya Y, Kitagawa T, Sata M (2011) Enhanced inflammation in epicardial fat in patients with coronary artery disease. Int Heart J 52:139–142CrossRefPubMed

43.

Kitagawa T, Yamamoto H, Sentani K, Takahashi S, Tsushima H, Senoo A, Yasui W, Sueda T, Kihara Y (2015) The relationship between inflammation and neoangiogenesis of epicardial adipose tissue and coronary atherosclerosis based on computed tomography analysis. Atherosclerosis 243:293–299CrossRefPubMed

44.

Hassan M, Said K, Rizk H, ElMogy F, Donya M, Houseni M, Yacoub M (2015) Segmental peri-coronary epicardial adipose tissue volume and coronary plaque characteristics. Eur Heart J Cardiovasc Imaging 17:1169–1177CrossRefPubMed

45.

Wu X, Mintz GS, Xu K, Lansky AJ, Witzenbichler B, Guagliumi G, Brodie B, Kellett MA Jr, Dressler O, Parise H, Mehran R, Stone GW, Maehara A (2011) The relationship between attenuated plaque identified by intravascular ultrasound and no-reflow after stenting in acute myocardial infarction: the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial. JACC Cardiovasc Interv 4:495–502CrossRefPubMed

46.

Lee T, Kakuta T, Yonetsu T, Takahashi K, Yamamoto G, Iesaka Y, Fujiwara H, Isobe M (2011) Assessment of echo-attenuated plaque by optical coherence tomography and its impact on post-procedural creatine kinase-myocardial band elevation in elective stent implantation. JACC Cardiovasc Interv 4:483–491CrossRefPubMed

47.

Burke AP, Kolodgie FD, Farb A, Weber DK, Malcom GT, Smialek J, Virmani R (2001) Healed plaque ruptures and sudden coronary death: evidence that subclinical rupture has a role in plaque progression. Circulation 103:934–940CrossRefPubMed

48.

Narula J, Nakano M, Virmani R, Kolodgie FD, Petersen R, Newcomb R, Malik S, Fuster V, Finn AV (2013) Histopathologic characteristics of atherosclerotic coronary disease and implications of the findings for the invasive and noninvasive detection of vulnerable plaques. J Am Coll Cardiol 61:1041–1051CrossRefPubMedPubMedCentral

49.

Cheng VY, Dey D, Tamarappoo B, Nakazato R, Gransar H, Miranda-Peats R, Ramesh A, Wong ND, Shaw LJ, Slomka PJ, Berman DS (2010) Pericardial fat burden on ECG-gated noncontrast CT in asymptomatic patients who subsequently experience adverse cardiovascular events. JACC Cardiovasc Imaging 3:352–360CrossRefPubMedPubMedCentral

50.

Mahabadi AA, Berg MH, Lehmann N, Kalsch H, Bauer M, Kara K, Dragano N, Moebus S, Jockel KH, Erbel R, Mohlenkamp S (2013) Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf Recall Study. J Am Coll Cardiol 61:1388–1395CrossRefPubMed

51.

Nissen SE, Nicholls SJ, Sipahi I, Libby P, Raichlen JS, Ballantyne CM, Davignon J, Erbel R, Fruchart JC, Tardif JC, Schoenhagen P, Crowe T, Cain V, Wolski K, Goormastic M, Tuzcu EM, ASTEROID Investigators (2006) Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA 295:1556–1565CrossRefPubMed

52.

Nakazato R, Rajani R, Cheng VY, Shmilovich H, Nakanishi R, Otaki Y, Gransar H, Slomka PJ, Hayes SW, Thomson LE, Friedman JD, Wong ND, Shaw LJ, Budoff M, Rozanski A, Berman DS, Dey D (2012) Weight change modulates epicardial fat burden: a 4-year serial study with non-contrast computed tomography. Atherosclerosis 220:139–144CrossRefPubMed

53.

Iacobellis G, Singh N, Wharton S, Sharma AM (2008) Substantial changes in epicardial fat thickness after weight loss in severely obese subjects. Obesity (Silver Spring) 16:1693–1697CrossRef

54.

Kim MK, Tomita T, Kim MJ, Sasai H, Maeda S, Tanaka K (2009) Aerobic exercise training reduces epicardial fat in obese men. J Appl Physiol (1985) 106:5–11CrossRef

55.

Fujimoto S, Hartung D, Ohshima S, Edwards DS, Zhou J, Yalamanchili P, Azure M, Fujimoto A, Isobe S, Matsumoto Y, Boersma H, Wong N, Yamazaki J, Narula N, Petrov A, Narula J (2008) Molecular imaging of matrix metalloproteinase in atherosclerotic lesions: resolution with dietary modification and statin therapy. J Am Coll Cardiol 52:1847–1857CrossRefPubMed

56.

Kawashiri MA, Sakata K, Gamou T, Kanaya H, Miwa K, Ueda K, Higashikata T, Mizuno S, Michishita I, Namura M, Nitta Y, Katsuda S, Okeie K, Hirase H, Tada H, Uchiyama K, Konno T, Hayashi K, Ino H, Nagase K, Terashima M, Yamagishi M (2015) Impact of combined lipid lowering with blood pressure control on coronary plaque regression: rationale and design of MILLION study. Heart Vessels 30:580–586CrossRefPubMed

57.

Nicholls SJ, Ballantyne CM, Barter PJ, Chapman MJ, Erbel RM, Libby P, Raichlen JS, Uno K, Borgman M, Wolski K, Nissen SE (2011) Effect of two intensive statin regimens on progression of coronary disease. New Eng J Med 365:2078–2087CrossRefPubMed

58.

Sever PS, Dahlöf B, Poulter NR, Wedel H, Beevers G, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O’Brien E, Ostergren J (2003) Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 361:1149–1158CrossRefPubMed

59.

Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ (2008) Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Eng J Med 359:2195–2207CrossRef

60.

Raber L, Taniwaki M, Zaugg S, Kelbaek H, Roffi M, Holmvang L, Noble S, Pedrazzini G, Moschovitis A, Luscher TF, Matter CM, Serruys PW, Juni P, Garcia-Garcia HM, Windecker S (2015) Effect of high-intensity statin therapy on atherosclerosis in non-infarct-related coronary arteries (IBIS-4): a serial intravascular ultrasonography study. Eur Heart J 36:490–500CrossRefPubMed

61.

Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM (2014) 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129:S1–S45CrossRefPubMed

62.

Oka T, Yamamoto H, Ohashi N, Kitagawa T, Kunita E, Utsunomiya H, Yamazato R, Urabe Y, Horiguchi J, Awai K, Kihara Y (2012) Association between epicardial adipose tissue volume and characteristics of non-calcified plaques assessed by coronary computed tomographic angiography. Int J Cardiol 161:45–49CrossRefPubMed

63.

Nakanishi K, Fukuda S, Tanaka A, Otsuka K, Jissho S, Taguchi H, Yoshikawa J, Shimada K (2014) Persistent epicardial adipose tissue accumulation is associated with coronary plaque vulnerability and future acute coronary syndrome in non-obese subjects with coronary artery disease. Atherosclerosis 237:353–360CrossRefPubMed

Title: Pericoronary adipose tissue ratio is a stronger associated factor of plaque vulnerability than epicardial adipose tissue on coronary computed tomography angiography
Authors: Ryo Okubo
Rine Nakanishi
Mikihito Toda
Daiga Saito
Ippei Watanabe
Takayuki Yabe
Hideo Amano
Tatsushi Hirai
Takanori Ikeda
Publication date: 01-07-2017
Publisher: Springer Japan
Published in: Heart and Vessels / Issue 7/2017
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-017-0943-1

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pericoronary adipose tissue ratio is a stronger associated factor of plaque vulnerability than epicardial adipose tissue on coronary computed tomography angiography

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 7/2017

Inferior vena cava diameter in acute decompensated heart failure as predictor of all-cause mortality

Combination of high-sensitivity troponin I and N-terminal pro-B-type natriuretic peptide predicts future hospital admission for heart failure in high-risk hypertensive patients with preserved left ventricular ejection fraction

Overlapping implantation of bioresorbable novolimus-eluting scaffolds: an observational optical coherence tomography study

Overestimation by echocardiography of the peak systolic pressure gradient between the right ventricle and right atrium due to tricuspid regurgitation and the usefulness of the early diastolic transpulmonary valve pressure gradient for estimating pulmonary artery pressure

Comparison of 8-frame and 16-frame thallium-201 gated myocardial perfusion SPECT for determining left ventricular systolic and diastolic parameters

Efficacy of everolimus-eluting stent implantation in patients with small coronary arteries (≤2.5 mm): outcomes of 3-year clinical follow-up

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page