Cardiometabolic predictors of high-risk CCTA phenotype in a diverse patient population

Toshiki Kuno; Javier Arce; Michael Fattouh; Sharmila Sarkar; John P. Skendelas; Jonathan Daich; Aldo L. Schenone; Lili Zhang; Carlos J. Rodriguez; Salim S. Virani; Piotr J. Slomka; Leslee J. Shaw; Eric E. Williamson; Daniel S. Berman; Mario J. Garcia; Damini Dey; Leandro Slipczuk

doi:10.1016/j.ajpc.2023.100578

Cardiometabolic predictors of high-risk CCTA phenotype in a diverse patient population

Toshiki Kuno, Javier Arce, Michael Fattouh, Sharmila Sarkar, John P. Skendelas, Jonathan Daich, Aldo L. Schenone, Lili Zhang, Carlos J. Rodriguez, Salim S. Virani, Piotr J. Slomka, Leslee J. Shaw, Eric E. Williamson, Daniel S. Berman, Mario J. Garcia, Damini Dey, Leandro Slipczuk

Medicine

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Introduction: Low-attenuation non-calcified plaque (LAP) burden and vascular inflammation by pericoronary adipose tissue (PCAT) measured from coronary CT angiography (CCTA) have shown to be predictors of cardiovascular outcomes. We aimed to investigate the relationships of cardiometabolic risk factors including lipoprotein(a) and epicardial adipose tissue (EAT) with CCTA high-risk imaging biomarkers, LAP and vascular inflammation. Methods: The patient population consisted of consecutive patients who underwent CCTA for stable chest pain and had a complete cardiometabolic panel including lipoprotein(a). Plaque, PCAT and EAT were measured from CT using semiautomated software. Elevated LAP burden and PCAT attenuation were defined as ≥4% and ≥70.5 HU, respectively. The primary clinical end-point was a composite of myocardial infarction, revascularization or cardiovascular death. Results: A total of 364 consecutive patients were included (median age 56 years, 64% female); the majority of patients were of Hispanic (60%), and the rest were of non-Hispanic Black (21%), non-Hispanic White (6%) and non-Hispanic Asian (4%) race/ethnicity. The prevalence of elevated LAP burden and PCAT attenuation was 31 and 18%, respectively, while only 8% had obstructive stenosis. There were significant differences in plaque characteristics among different racial/ethnic groups (p<0.001). Lipoprotein(a) correlated with LAP burden in Hispanic patients. Patients with elevated LAP were older, more likely to be have diabetes, hypertension, hyperlipidemia and smoke with higher CAC and EAT volume (all P<0.05). Patients with elevated LAP were more likely to develop the primary clinical outcome (p<0.001) but those with elevated PCAT were not (p=0.797). Conclusion: The prevalence of LAP and PCAT attenuation were 31 and 18%, respectively. Lipoprotein(a) levels correlated with LAP burden in Hispanic patients. Age, male sex, hypertension and hyperlipidemia increased the odds of elevated LAP, which showed prognostic significance.

Original language	English (US)
Article number	100578
Journal	American Journal of Preventive Cardiology
Volume	15
DOIs	https://doi.org/10.1016/j.ajpc.2023.100578
State	Published - Sep 2023

Keywords

CT coronary angiogram
Epicardial adipose tissue
High-risk plaque
LAP
PCAT
Risk factors

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ajpc.2023.100578

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Kuno, T., Arce, J., Fattouh, M., Sarkar, S., Skendelas, J. P., Daich, J., Schenone, A. L., Zhang, L., Rodriguez, C. J., Virani, S. S., Slomka, P. J., Shaw, L. J., Williamson, E. E., Berman, D. S., Garcia, M. J., Dey, D., & Slipczuk, L. (2023). Cardiometabolic predictors of high-risk CCTA phenotype in a diverse patient population. American Journal of Preventive Cardiology, 15, Article 100578. https://doi.org/10.1016/j.ajpc.2023.100578

Kuno, T, Arce, J, Fattouh, M, Sarkar, S, Skendelas, JP, Daich, J, Schenone, AL , Zhang, L , Rodriguez, CJ, Virani, SS, Slomka, PJ, Shaw, LJ, Williamson, EE, Berman, DS, Garcia, MJ, Dey, D & Slipczuk, L 2023, 'Cardiometabolic predictors of high-risk CCTA phenotype in a diverse patient population', American Journal of Preventive Cardiology, vol. 15, 100578. https://doi.org/10.1016/j.ajpc.2023.100578

@article{7756cac9212b41cf84b666ee73635bac,

title = "Cardiometabolic predictors of high-risk CCTA phenotype in a diverse patient population",

abstract = "Introduction: Low-attenuation non-calcified plaque (LAP) burden and vascular inflammation by pericoronary adipose tissue (PCAT) measured from coronary CT angiography (CCTA) have shown to be predictors of cardiovascular outcomes. We aimed to investigate the relationships of cardiometabolic risk factors including lipoprotein(a) and epicardial adipose tissue (EAT) with CCTA high-risk imaging biomarkers, LAP and vascular inflammation. Methods: The patient population consisted of consecutive patients who underwent CCTA for stable chest pain and had a complete cardiometabolic panel including lipoprotein(a). Plaque, PCAT and EAT were measured from CT using semiautomated software. Elevated LAP burden and PCAT attenuation were defined as ≥4% and ≥70.5 HU, respectively. The primary clinical end-point was a composite of myocardial infarction, revascularization or cardiovascular death. Results: A total of 364 consecutive patients were included (median age 56 years, 64% female); the majority of patients were of Hispanic (60%), and the rest were of non-Hispanic Black (21%), non-Hispanic White (6%) and non-Hispanic Asian (4%) race/ethnicity. The prevalence of elevated LAP burden and PCAT attenuation was 31 and 18%, respectively, while only 8% had obstructive stenosis. There were significant differences in plaque characteristics among different racial/ethnic groups (p<0.001). Lipoprotein(a) correlated with LAP burden in Hispanic patients. Patients with elevated LAP were older, more likely to be have diabetes, hypertension, hyperlipidemia and smoke with higher CAC and EAT volume (all P<0.05). Patients with elevated LAP were more likely to develop the primary clinical outcome (p<0.001) but those with elevated PCAT were not (p=0.797). Conclusion: The prevalence of LAP and PCAT attenuation were 31 and 18%, respectively. Lipoprotein(a) levels correlated with LAP burden in Hispanic patients. Age, male sex, hypertension and hyperlipidemia increased the odds of elevated LAP, which showed prognostic significance.",

keywords = "CT coronary angiogram, Epicardial adipose tissue, High-risk plaque, LAP, PCAT, Risk factors",

author = "Toshiki Kuno and Javier Arce and Michael Fattouh and Sharmila Sarkar and Skendelas, {John P.} and Jonathan Daich and Schenone, {Aldo L.} and Lili Zhang and Rodriguez, {Carlos J.} and Virani, {Salim S.} and Slomka, {Piotr J.} and Shaw, {Leslee J.} and Williamson, {Eric E.} and Berman, {Daniel S.} and Garcia, {Mario J.} and Damini Dey and Leandro Slipczuk",

note = "Publisher Copyright: {\textcopyright} 2023 The Author(s)",

year = "2023",

month = sep,

doi = "10.1016/j.ajpc.2023.100578",

language = "English (US)",

volume = "15",

journal = "American Journal of Preventive Cardiology",

issn = "2666-6677",

publisher = "Elsevier BV",

}

TY - JOUR

T1 - Cardiometabolic predictors of high-risk CCTA phenotype in a diverse patient population

AU - Kuno, Toshiki

AU - Arce, Javier

AU - Fattouh, Michael

AU - Sarkar, Sharmila

AU - Skendelas, John P.

AU - Daich, Jonathan

AU - Schenone, Aldo L.

AU - Zhang, Lili

AU - Rodriguez, Carlos J.

AU - Virani, Salim S.

AU - Slomka, Piotr J.

AU - Shaw, Leslee J.

AU - Williamson, Eric E.

AU - Berman, Daniel S.

AU - Garcia, Mario J.

AU - Dey, Damini

AU - Slipczuk, Leandro

PY - 2023/9

Y1 - 2023/9

N2 - Introduction: Low-attenuation non-calcified plaque (LAP) burden and vascular inflammation by pericoronary adipose tissue (PCAT) measured from coronary CT angiography (CCTA) have shown to be predictors of cardiovascular outcomes. We aimed to investigate the relationships of cardiometabolic risk factors including lipoprotein(a) and epicardial adipose tissue (EAT) with CCTA high-risk imaging biomarkers, LAP and vascular inflammation. Methods: The patient population consisted of consecutive patients who underwent CCTA for stable chest pain and had a complete cardiometabolic panel including lipoprotein(a). Plaque, PCAT and EAT were measured from CT using semiautomated software. Elevated LAP burden and PCAT attenuation were defined as ≥4% and ≥70.5 HU, respectively. The primary clinical end-point was a composite of myocardial infarction, revascularization or cardiovascular death. Results: A total of 364 consecutive patients were included (median age 56 years, 64% female); the majority of patients were of Hispanic (60%), and the rest were of non-Hispanic Black (21%), non-Hispanic White (6%) and non-Hispanic Asian (4%) race/ethnicity. The prevalence of elevated LAP burden and PCAT attenuation was 31 and 18%, respectively, while only 8% had obstructive stenosis. There were significant differences in plaque characteristics among different racial/ethnic groups (p<0.001). Lipoprotein(a) correlated with LAP burden in Hispanic patients. Patients with elevated LAP were older, more likely to be have diabetes, hypertension, hyperlipidemia and smoke with higher CAC and EAT volume (all P<0.05). Patients with elevated LAP were more likely to develop the primary clinical outcome (p<0.001) but those with elevated PCAT were not (p=0.797). Conclusion: The prevalence of LAP and PCAT attenuation were 31 and 18%, respectively. Lipoprotein(a) levels correlated with LAP burden in Hispanic patients. Age, male sex, hypertension and hyperlipidemia increased the odds of elevated LAP, which showed prognostic significance.

AB - Introduction: Low-attenuation non-calcified plaque (LAP) burden and vascular inflammation by pericoronary adipose tissue (PCAT) measured from coronary CT angiography (CCTA) have shown to be predictors of cardiovascular outcomes. We aimed to investigate the relationships of cardiometabolic risk factors including lipoprotein(a) and epicardial adipose tissue (EAT) with CCTA high-risk imaging biomarkers, LAP and vascular inflammation. Methods: The patient population consisted of consecutive patients who underwent CCTA for stable chest pain and had a complete cardiometabolic panel including lipoprotein(a). Plaque, PCAT and EAT were measured from CT using semiautomated software. Elevated LAP burden and PCAT attenuation were defined as ≥4% and ≥70.5 HU, respectively. The primary clinical end-point was a composite of myocardial infarction, revascularization or cardiovascular death. Results: A total of 364 consecutive patients were included (median age 56 years, 64% female); the majority of patients were of Hispanic (60%), and the rest were of non-Hispanic Black (21%), non-Hispanic White (6%) and non-Hispanic Asian (4%) race/ethnicity. The prevalence of elevated LAP burden and PCAT attenuation was 31 and 18%, respectively, while only 8% had obstructive stenosis. There were significant differences in plaque characteristics among different racial/ethnic groups (p<0.001). Lipoprotein(a) correlated with LAP burden in Hispanic patients. Patients with elevated LAP were older, more likely to be have diabetes, hypertension, hyperlipidemia and smoke with higher CAC and EAT volume (all P<0.05). Patients with elevated LAP were more likely to develop the primary clinical outcome (p<0.001) but those with elevated PCAT were not (p=0.797). Conclusion: The prevalence of LAP and PCAT attenuation were 31 and 18%, respectively. Lipoprotein(a) levels correlated with LAP burden in Hispanic patients. Age, male sex, hypertension and hyperlipidemia increased the odds of elevated LAP, which showed prognostic significance.

KW - CT coronary angiogram

KW - Epicardial adipose tissue

KW - High-risk plaque

KW - LAP

KW - PCAT

KW - Risk factors

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DO - 10.1016/j.ajpc.2023.100578

M3 - Article

AN - SCOPUS:85168751377

SN - 2666-6677

VL - 15

JO - American Journal of Preventive Cardiology

JF - American Journal of Preventive Cardiology

M1 - 100578

ER -

Cardiometabolic predictors of high-risk CCTA phenotype in a diverse patient population

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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