Abstract of the day: PCAT attenuation as a tool for CV risk stratification in type 2 diabetes mellitus
30 Aug 2021
Abstract of the day
Attenuation of peri-coronary adipose tissue (PCAT) on coronary computed tomography angiography (CTA) is an indication of peri-coronary inflammation. Available on demand, Doctor Keishi Ichikawa (Okayama University, Japan) presents results investigating whether high PCAT attenuation may help to identify patients with type 2 diabetes mellitus (T2DM) who are at a high risk of cardiovascular (CV) events.
This post-hoc analysis of a prospective cohort study involved patients with T2DM undergoing clinically indicated coronary CTA at a Japanese University hospital. Coronary artery calcium score, epicardial tissue volume, high-risk plaque features and PCAT attenuation (measured in Hounsfield units [HU] of proximal 40 mm segments of the left anterior descending artery) were assessed on CT. CV events were defined as CV death, acute coronary syndrome and hospitalisation for heart failure.
Among 333 patients, with a mean PCAT attenuation of −70.6 ± 6.1 HU, there were 20 confirmed CV events during the 4.2-year follow-up. PCAT attenuation was higher in patients with CV events than without CV events (−67.4 vs. −70.8 HU; p=0.013). In univariate Cox regression analyses, high-risk plaque features (p=0.035), significant stenosis (p=0.022) and PCAT attenuation (p=0.005) were significantly associated with CV events, while coronary artery calcium (p=0.055) and epicardial adipose tissue (p=0.449) were not. Indeed, in multivariate Cox regression analysis, PCAT attenuation was independently associated with CV events after adjustment for coronary CTA findings and traditional CV risk factors (hazard ratio 1.105; 95% confidence interval 1.017 to 1.200; p=0.018).
According to receiver operating characteristic curve analysis, the optimal cut-off value for PCAT attenuation to predict CV events was −69.3 HU (sensitivity 58.5%, specificity 65.0%). Using this cut-off, patients with high PCAT attenuation had significantly more CV events than those with a lower PCAT attenuation over the follow-up period (9% vs. 3%; p=0.013; log-rank test).
The authors concluded that PCAT attenuation could be a valuable tool for CV risk prediction in patients with T2DM.
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