Adipose tissue (AT) is no longer viewed as a passive, energy-storing depot, and a growing body of evidence supports the concept that both quantitative and qualitative aspects of AT are critical in determining an individual’s cardiometabolic risk profile. Among all AT sites, perivascular AT (PVAT) has emerged as a depot with a distinctive biological significance in cardiovascular disease given its close anatomical proximity to the vasculature. Recent studies have suggested the presence of complex, bidirectional paracrine and vasocrine signalling pathways between the vascular wall and its PVAT, with far-reaching implications in cardiovascular diagnostics and therapeutics. In this review, we first discuss the biological role of PVAT in both cardiovascular health and disease, highlighting its dual pro-atherogenic and anti-atherogenic roles, as well as potential therapeutic targets in cardiovascular disease. We then review current evidence and promising new modalities on the non-invasive imaging of epicardial AT and PVAT. Specifically, we present how our expanding knowledge on the bidirectional interplay between the vascular wall and its PVAT can be translated into novel clinical diagnostics tools to assess coronary inflammation. To this end, we present the example of a new CT-based method that tracks spatial changes in PVAT phenotype to extract information about the inflammatory status of the adjacent vasculature, highlighting the numerous diagnostic and therapeutic opportunities that arise from our increased understanding of PVAT biology.
- perivascular AT
- epicardial AT
- pericoronary AT
- coronary atherosclerosis
- computed tomography angiography
- fat attenuation index
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JM and EKO contributed equally.
Contributors JM performed the search on the literature database, wrote the manuscript and created the tables. EKO contributed to the writing of the manuscript and created the figures. CA gave scientific direction, contributed to writing the manuscript, read and accepted the final version of the manuscript.
Funding CA acknowledges funding by the British Heart Foundation (FS/16/15/32047 and TG/16/3/32687) and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. EKO acknowledges funding by the State Scholarships Foundation of Greece (Leonidas Nikolaidis scholarship). This work was supported by the Tripartite Immunometabolism Consortium (TrIC)–Novo Nordisk Foundation; grant number NNF15CC0018486.
Competing interests The methods for analysis of perivascular Fat Attenuation Index (FAI) described in this manuscript are subject to patent applications, numbers PCT/GB2015/052359 and GB1620494.3. CA is a founder and shareholder of Caristo Diagnostics, a CT image analysis company.
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Provenance and peer review Commissioned; externally peer reviewed.