Introduction

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 …