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Pericoronary adipose tissue CT attenuation in coronary artery plaque inflammation
  1. Xinming Yu1,
  2. Simona Botezatu1,2,
  3. Evangelos Tzolos1,
  4. Damini Dey3,
  5. Jacek Kwiecinski4
  1. 1 British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  2. 2 Cardiology Department, Euroecolab, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
  3. 3 Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
  4. 4 Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
  1. Correspondence to Dr Damini Dey, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; damini.dey{at}

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Learning objectives

  • The bidirectional relationship between coronary vessel inflammation and the pericoronary adipose tissue.

  • The use of pericoronary adipose tissue CT attenuation to measure coronary artery inflammation.

  • The current literature on the use of pericoronary adipose tissue CT attenuation in coronary artery disease.

  • The strengths and limitations of this image analysis technique and future perspectives.


Coronary artery disease (CAD) is associated with significant morbidity and mortality.1 Despite the improving trend of mortality in a number of European countries, cardiovascular disease remains the leading cause of death in Europe, accounting for over 4 million deaths each year.1 Therefore, there is a great need for new tools that are able to predict adverse outcomes and stratify risk in CAD.

Novel non-invasive imaging methods to quantify plaque inflammation, which plays an important role in coronary atherosclerosis, may prove of value in the identification of early disease as well as high-risk patients who may benefit from targeted therapy.2 This is of particular importance, given the recent promise demonstrated by anti-inflammatory therapy in randomised controlled trials.3 The ability to reliably measure inflammatory activity in CAD may well prove crucial in targeting the powerful treatments to the right patient at the right time. In current clinical practice, inflammation can either be depicted with advanced imaging or characterised with blood biomarkers. While the latter lacks specificity for CAD, novel advanced cardiac imaging approaches showed promise in this regard.

Measurement of pericoronary adipose tissue (PCAT) attenuation on CT is a recently developed imaging technique that evaluates coronary artery inflammatory activity on routinely acquired coronary CT angiograms (CCTAs). In this review, we will first describe the pathophysiological mechanisms underlying coronary vascular inflammation and how these might modify the surrounding coronary perivascular fat. We will then present the current PCAT CT attenuation literature before finally describing potential future clinical …

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  • XY and SB are joint first authors.

  • DD and JK are joint senior authors.

  • Twitter @TzolosEvangelos

  • XY and SB contributed equally.

  • DD and JK contributed equally.

  • Contributors All authors were involved in the drafting and revision process of this article. All authors read and approved the manuscript.

  • Funding SB is supported by a Romanian Society of Cardiology Research Grant (contract number 266/8.06.2021). DD is supported by National Institutes of Health/National Heart, Lung, and Blood Institute (grants 1R01HL148787-01A1 and 1R01HL151266).

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note References which include a * are considered to be key references.