Pericoronary adipose tissue attenuation: diagnostic and prognostic implications
Pieter van der Bijl, Jurriën H. Kuneman, Jeroen J. Bax
Abstract
This editorial refers to ‘Pericoronary Fat Attenuation Index – A new imaging biomarker and its diagnostic and prognostic utility: A systematic review and meta-analysis’, by M. Sagris et al. https://doi.org/10.1093/ehjci/jeac174. Contrast-enhanced coronary computed tomography (CT) is a well-established technique to visualize the anatomy of the coronary arteries and to estimate the degree of stenosis. Quantification of the coronary artery calcium burden with a non-contrast CT scan adds value to patient risk-stratification.1 Measuring coronary blood flow impairment by means of CT coronary artery fractional flow reserve and CT perfusion imaging are emerging technologies for obtaining functional information on the supply–demand relationship of the myocardium and its blood supply.2 CT has the edge over the majority of cardiac imaging techniques by allowing accurate co-localization of myocardial ischaemia and the causative coronary lesion(s). While this is useful in chronic coronary syndromes, most myocardial infarcts occur in segments without obstructive disease.3 This is thought to be mainly due to the rupture of extraluminal plaque—the latter which can be visualized with CT coronary angiography. Predicting which extraluminal, non-obstructive plaques are apt to rupture and cause acute coronary syndromes, remains challenging with current imaging technologies. Certain CT characteristics of vulnerable plaque have been described and correlated with thin-cap atheromata on intravascular ultrasound (IVUS), e.g. spotty calcification, a napkin ring sign, and positive remodelling. The positive predictive value of these morphological risk markers, however, is low, limiting their clinical utility.4,5