| Objective:We examined the correlation between peri-coronary adipose tissue(PCAT)volume and mean attenuation in patients with suspected coronary heart disease(CHD)who had previously undergone coronary computed tomography angiography(CCTA).The correlation between the volume and average attenuation of peri-coronary adipose tissue(PCAT)and CHD was investigated in conjunction with lipid indices(univariate or multifactorial strong correlation).This will better guide the selection of the best treatment plan for patients.Methods:From 06/2019 to 07/2022,152 patients with severe coronary stenosis(≥ 50%)diagnosed by digital subtraction angiography(DSA)and diagnosed with CHD in the experimental group were selected to attend the Department of Cardiovascular Medicine at the First Hospital of Jilin University,where 152 patients were diagnosed by DSA in the control group.In the control group,55 patients with mild to moderate or no coronary artery stenosis(<50%)were diagnosed with non-coronary heart disease(N-CHD).The CCTA examination was later than the DSA examination in 7 patients,and the longest interval between the two examinations was 167 days,with a mean interval of 7.53 days.General data such as gender,age,height,weight,previous history of hypertension and diabetes,and clinical data such as leukocytes,markers of myocardial injury,B-type natriuretic peptide(BNP),D-dimer,creatine,blood uric acid,potassium ion,blood lipids,fasting glucose,electrocardiogram,extent and nature of proximal plaque of CCTA,visceral fat were collected and compiled respectively.The data were collected and organized.Data were collected by using imaging software(Lian Ying)to calculate 0-40 mm of the left anterior descending coronary artery(LAD)and left circumflex coronary artery(LCX)for each patient,and 0-40 mm of the proximal right coronary artery(RCA)for each patient.The PCAT volume and mean attenuation,i.e.,the fat attenuation index(FAI)of the three coronary arteries of the right coronary artery(RCA)of 10-50 mm were analyzed by statistical software to investigate the effect of PCAT-related index levels on CHD in different subgroups of patients with CHD in relation to each relevant factor.Results:(1)The mean age,triglycerides,leukocytes,blood uric acid,fasting glucose,BNP,positive D-dimer,hyperlipidemia,hypertension and diabetes were higher in the CHD group than in the N-CHD group,which was statistically significant.(2)The mean levels of FAI values of RCA,LAD,and LCX in the CHD group were higher than those in the N-CHD group,and the differences were statistically significant;the mean levels of the sum of adipose tissue volumes around the three vessels in the CHD group were lower than those in the N-CHD group,and the differences were statistically significant(Z=3.512,p<0.001).FAI values of RCA and surrounding fat volume sum had independent effects on CHD,as corrected by logistic regression analysis.For FAI value of RCA,the higher the value,the higher the risk of CHD,with an OR of 1.057 and 95% CI of 1.002 to1.116;for the sum of surrounding adipose tissue volume of three vessels,the higher the value,the lower the risk of CHD,with an OR of 0.967 and 95% CI of 0.936 to 0.999.(3)RCA showed that the mean age,triglycerides,mean fasting glucose level,proportion of positive D-dimer,proportion of males,and proportion with hypertensive disease and diabetes were higher with stenosis than without stenosis,and the difference was statistically significant.For RCA fat volume,the difference in fat volume between those with and without stenosis was not statistically significant(Z=1.008,p=0.313);for FAI value of RCA,the FAI value of RCA with stenosis was lower than that without stenosis,and the difference was statistically significant(t=3.092,p=0.002).(4)The degree of stenosis was negatively correlated with RCA fat volume and positively correlated with FAI values of RCA in CHD patients,which was statistically significant.The differences in fat volume and FAI values between different plaque properties were not statistically significant.(5)LAD showed that the mean age,body mass index(BMI),triglycerides,white blood cells,fasting glucose,mean BNP level,proportion of positive D-dimer,and proportion with hypertension and diabetes were higher in those with stenosis than those without stenosis,and the difference was statistically significant.The fat volume with stenosis was smaller than that without stenosis,and the difference was statistically significant(Z=2.221,p=0.026);the difference in FAI values between LAD with and without stenosis was not statistically significant(Z=0.988,p=0.323).Corrected by logistic regression analysis,fat volume of LAD had an important effect on stenosis of LAD,and the higher the fat volume of LAD,the lower the risk of LAD stenosis,with an OR of 0.884 and 95% CI of 0.809-0.965;FAI value of LAD had no effect on stenosis of LAD by analysis.(6)Fat volume of LAD was negatively correlated with the degree of stenosis of LAD and FAI value of LAD was positively correlated with the degree of stenosis of LAD in patients with CHD,but none of the correlations were statistically significant(p>0.05).The differences in fat volume and FAI values between different plaque properties were not statistically significant.(7)LCX showed that the mean age,BMI,mean level of fasting glucose,proportion of positive D-dimer,and proportion with hypertensive disease and diabetes were higher in those with stenosis than in those without stenosis,and the differences were statistically significant.The fat volume with stenosis was smaller than that without stenosis,but the difference was not statistically significant;the difference in FAI values between those with and without stenosis was not statistically significant.Correction by logistic regression analysis showed that both fat volume and FAI value of LCX had no effect on the stenosis of LCX.(8)The fat volume of LCX was negatively correlated with the degree of stenosis of LCX,and the FAI value of LCX was positively correlated with the degree of stenosis of LCX in patients with CHD,but the correlation was not statistically significant(p>0.05).The difference in fat volume between different plaque properties was statistically significant,and further two-by-two comparison showed that the fat volume of calcified plaques was smaller than that of mixed plaques,which was statistically significant(p<0.05).Comparison showed no statistically significant difference in FAI values between plaque properties(F=0.209,p=0.811).(9)Comparison of CCTA examination of RCA vessels with DSA examination results showed that the number of people with stenosis of <50% in both methods was 69,and the number of people with stenosis of ≥50% in both methods was 34,and the agreement rate between the two methods was 67.76%.Using DSA examination as the gold standard,the sensitivity of CCTA examination for the diagnosis of RCA stenosis ≥50% was 69.39%,the specificity was 66.99%,and the correct index was 0.364.(10)Comparison of CCTA examination and DSA examination results of LAD vessels,the number of people with stenosis of <50% in both methods was 14,and the number of people with stenosis of ≥50% in both methods was 95,and the agreement rate of both methods was 71.71%.Using DSA examination as the gold standard,the sensitivity of CCTA examination for the diagnosis of LAD stenosis ≥50% was 91.35%,the specificity was29.17%,and the correct index was 0.205.(11)Comparing the results of CCTA examination and DSA examination of LCX vessels,the number of people with stenosis of <50% in both methods was 80,and the number of people with stenosis of ≥50% in both methods was 25,and the agreement rate between the two methods was 69.08%.Using DSA examination as the gold standard,the sensitivity of CCTA examination for the diagnosis of LCX stenosis ≥50% was 80.65%,the specificity was66.12%,and the correct index was 0.468.(12)Visceral fat was positively correlated with LAD fat volume in CHD patients,with a Spearman correlation coefficient of 0.433,which was statistically significant(p=0.006);visceral fat was positively correlated with FAI value of LCX,with a Spearman correlation coefficient of 0.358,which was statistically significant(p=0.025).The correlations between visceral fat and other PCAT-related indicators were not statistically significant by analysis(p>0.05).Conclusions:1.FAI value of RCA has an important effect on CHD.For the FAI value of RCA,the higher the value,the higher the risk of CHD.2.The fat volume of LCX calcified plaques was statistically smaller than that of mixed plaques in CHD patients;the difference in FAI values among different plaque properties of RCA,LAD,and LCX was not statistically significant.3.Visceral fat in CHD patients was positively correlated with LAD fat volume and positively correlated with FAI value of LCX.The correlation between visceral fat and other vascular fat indicators were not statistically significant by analysis. |
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