Periaortic Adipose Tissue Index: A New Approach to the Relationship between Coronary Stenosis Severity/Lesion Complexity and Periaortic Adipose Tissue

Abstract

Periaortic adipose tissue (PAT) is associated with atherosclerosis. The severity of coronary stenosis with PAT has not been evaluated with conventional coronary angiography (CAG). The aim of the study is to determine the relationship between PAT and coronary stenosis severity/ complexity, and to evaluate it with the periaortic adipose tissue index (PATI), a new index derived from PAT. Patients who underwent CAG and thoracic computed tomography (CT) between January 2017 and January 2022 were included in the study. PAT volume was calculated by evaluating CT images, and PATI was calculated by dividing the PAT volume by the circumference of the descending aorta. Patients were divided into two groups according to the presence of ≥50% stenosis on CAG. The correlation of PAT and PATI with the SYNTAX score was evaluated. In our study, 263 patients [mean age 64.5(54/72), male 164 (62.4%)] were evaluated. Severe coronary artery disease (CAD) was observed in 181 patients (68.8%). PAT volume and PATI were significantly higher in patients with severe stenosis (p<0.001, for both). When PAT and PATI were evaluated alongside CAD risk factors, an independent association between PATI and severe CAD was discovered (β:0.581, p:0.97, β:0.968, p:0.006, respectively). No correlation was found between SYNTAX score and PAT and PATI (r:-0.026, p:0.73, r:-0.019, p:0.19, respectively). In our study, PAT and PATI were higher in patients with severe coronary stenosis, and there was an independent relationship between PATI and severe stenosis. We found no relationship between PAT and PATI and the SYNTAX score.

Keywords

• coronary artery disease
• periaortic adipose tissue
• syntax score
• coronary angiography
• computed tomography

Abstract

Periaortik yağ dokusu (PYD) ile ateroskleroz ile ilişkilidir. PYD ile koroner darlık ciddiyeti konvansiyonel koroner anjiyografi (KAG) ile değerlendirilmemiştir. Çalışmanın amacı, PYD ile koroner darlık ciddiyeti/yaygınlığı arasındaki ilişkiyi saptamak, ek olarak, PYD’den türetilen yeni bir indeks olan periaortik yağ dokusu indeksi (PYDI) ile değerlendirmektir. Ocak 2017 ile Ocak 2022 tarihleri arasında KAG ve toraks bilgisayarlı tomografisi (BT) yapılan hastalar çalışmaya dahil edildi. PYD volümü BT görüntüleri değerlendirilerek, PYDI ise, PYD volümünün desendan aort çevresine bölünmesiyle hesaplandı. KAG’de ≥%50 darlık varlığına göre hastalar iki gruba ayrıldı. PYD ve PYDI'nın SYNTAX puanı ile korelasyonu değerlendirildi. Çalışmamızda 263 hasta [ortalama yaş 64.5(54/72), erkek 164 (%62.4)) değerlendirildi. 181 hastada (%68.8) ciddi KAH görüldü. Ciddi darlık bulunanlarda PYD hacmi ve PYDI anlamlı olarak daha yüksekti (her ikisi için p<0,001). PYD ve PYDI, KAH risk faktörleri ile birlikte değerlendirildiğinde, PYDI ile ciddi KAH arasında bağımsız bir ilişki bulundu (β:0.581, p:0.097, β:0.968, p:0.006, sırasıyla). SYNTAX skoru ile PYD ve PYDI arasında korelasyon bulunmadı (r:-0.026, p:0.73, r:-0.019, p:0.19, sırasıyla). Çalışmamızda PYD ve PYDI ciddi koroner darlığı bulunanlarda daha yüksekti, ayrıca PYDI ile ciddi darlık arasında bağımsız bir ilişki mevcuttu. PYD ve PYDI ile SYNTAX skoru arasında ilişki saptamadık.

Keywords

• koroner arter hastalığı
• periaortik yağ dokusu
• syntax skoru
• koroner anjiyografi
• bilgisayarlı tomografi

References

1. Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. Journal of cellular physiology. 2019;234(10):16812-16823.
2. Lehman SJ, Massaro JM, Schlett CL, O'Donnell CJ, Hoffmann U, Fox CS. Peri-aortic fat, cardiovascular disease risk factors, and aortic calcification: the Framingham Heart Study. Atherosclerosis. 2010;210(2):656-661.
3. Chatterjee TK, Stoll LL, Denning GM, Harrelson A, Blomkalns AL, Idelman G, et al. Proinflammatory phenotype of perivascular adipocytes: influence of high-fat feeding. Circulation research. 2009;104(4):541-549.
4. Thanigaimani S, Golledge J. Role of Adipokines and Perivascular Adipose Tissue in Abdominal Aortic Aneurysm: A Systematic Review and Meta-Analysis of Animal and Human Observational Studies. Frontiers in endocrinology. 2021;12:618434.
5. Yun CH, Longenecker CT, Chang HR, Mok GS, Sun JY, Liu CC, et al. The association among peri-aortic root adipose tissue, metabolic derangements and burden of atherosclerosis in asymptomatic population. Journal of cardiovascular computed tomography. 2016;10(1):44-51.
6. Erkan AF, Tanindi A, Kocaman SA, Ugurlu M, Tore HF. Epicardial Adipose Tissue Thickness Is an Independent Predictor of Critical and Complex Coronary Artery Disease by Gensini and Syntax Scores. Texas Heart Institute journal. 2016;43(1):29-37.
7. Kaya M, Yeniterzi M, Yazici P, Diker M, Celik O, Ertürk M, et al. Epicardial adipose tissue is associated with extensive coronary artery lesions in patients undergoing coronary artery bypass grafting: an observational study. Maedica. 2014;9(2):135-143.
8. Mangili LC, Mangili OC, Bittencourt MS, Miname MH, Harada PH, Lima LM, et al. Epicardial fat is associated with severity of subclinical coronary atherosclerosis in familial hypercholesterolemia. Atherosclerosis. 2016;254:73-77.

9. Mancio J, Azevedo D, Saraiva F, Azevedo AI, Pires-Morais G, Leite-Moreira A, et al. Epicardial adipose tissue volume assessed by computed tomography and coronary artery disease: a systematic review and meta-analysis. European heart journal. Cardiovascular Imaging. 2018;19(5):490-497.
10. Efe D, Aygün F, Ulucan Ş, Keser A. Relationship of coronary artery disease with pericardial and periaortic adipose tissue and their volume detected by MSCT. Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese. 2015;56(1):44-54.
11. Fox CS, Massaro JM, Schlett CL, Lehman SJ, Meigs JB, O'Donnell CJ, et al. Periaortic fat deposition is associated with peripheral arterial disease: the Framingham heart study. Circulation. Cardiovascular imaging. 2010;3(5):515-519.
12. Thanassoulis G, Massaro JM, Corsini E, Rogers I, Schlett CL, Meigs JB, et al. Periaortic adipose tissue and aortic dimensions in the Framingham Heart Study. Journal of the American Heart Association. 2012;1(6):e000885.
13. Yamaguchi M, Yonetsu T, Hoshino M, Sugiyama T, Kanaji Y, Yasui Y, et al. Clinical Significance of Increased Computed Tomography Attenuation of Periaortic Adipose Tissue in Patients With Abdominal Aortic Aneurysms. Circulation journal : official journal of the Japanese Circulation Society. 2021;85(12):2172-2180.
14. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177.
15. Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289-1367.
16. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal. 2019;41(3):407-477.
17. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Annals of internal medicine. 2009;150(9):604-612.
18. Textor J, van der Zander B, Gilthorpe MS, Liskiewicz M, Ellison GT. Robust causal inference using directed acyclic graphs: the R package 'dagitty'. International journal of epidemiology. 2016;45(6):1887-1894.
19. Tchernof A, Després JP. Pathophysiology of human visceral obesity: an update. Physiological reviews. 2013;93(1):359-404.
20. Eckel RH, Krauss RM. American Heart Association call to action: obesity as a major risk factor for coronary heart disease. AHA Nutrition Committee. Circulation. 1998;97(21):2099-2100.
21. Mazzotta C, Basu S, Gower AC, Karki S, Farb MG, Sroczynski E, et al. Perivascular Adipose Tissue Inflammation in Ischemic Heart Disease. Arteriosclerosis, thrombosis, and vascular biology. 2021;41(3):1239-1250.
22. Henrichot E, Juge-Aubry CE, Pernin A, Pache JC, Velebit V, Dayer JM, et al. Production of chemokines by perivascular adipose tissue: a role in the pathogenesis of atherosclerosis? Arteriosclerosis, thrombosis, and vascular biology. 2005;25(12):2594-2599.
23. Zhu J, Yang Z, Li X, Chen X, Pi J, Zhuang T, et al. Association of Periaortic Fat and Abdominal Visceral Fat with Coronary Artery Atherosclerosis in Chinese Middle Aged and Elderly Patients Undergoing Computed Tomography Coronary Angiography. Global heart. 2021;16(1):74.
24. Turkmen K, Ozbek O, Kayrak M, Samur C, Guler I, Tonbul HZ. Peri-aortic fat tissue thickness in peritoneal dialysis patients. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis. 2013;33(3):316-324.
25. Resorlu M, Karatag O, Toprak CA, Ozturk MO. Neglected areas on thorax computed tomography evaluation in patients with chronic obstructive pulmonary disease: Paravertebral muscles and para-aortic adipose tissue. Journal of medical imaging and radiation oncology. 2018.
26. Rodríguez-Granillo GA, Cirio JJ, Ciardi C, Caballero ML, Fontana L, Pérez N, et al. Epicardial and periaortic fat characteristics in ischemic stroke: Relationship with stroke etiology and calcification burden. European journal of radiology. 2022;146:110102.
27. Mamopoulos AT, Freyhardt P, Touloumtzidis A, Zapenko A, Katoh M, Gäbel G. Quantification of periaortic adipose tissue in contrast-enhanced CT angiography: technical feasibility and methodological considerations. The international journal of cardiovascular imaging. 2022.