Study On The Characteristics Of Pericoronary Adipose Tissue In Patients With HIV Infection By Coronary Computed Tomographic Angiography

Background and ObjectiveRecent studies have indicated that the epicardial adipose tissue(EAT),through paracrine secretion of inflammatory cytokines,plays an important role in cardiovascular disease.The perivascular fat attenuation index(FAI),a novel imaging biomarker for assessing coronary inflammation in standard coronary computed tomographic angiography(CCTA),captures spatial changes in perivascular fat composition.We hypothesized that the infection status of HIV and high-efficiency antiretroviral therapy may affect perivascular FAI and the volume and density of EAT.These important parameters may be linked to the risk of cardiovascular disease and future adverse cardiovascular events in patients living with HIV.Our aim was to explore the differences in perivascular FAI and the volume and density of EAT between HIV-infected and non-HIV-infected patients,and to further explore the influencing factors of perivascular FAI and the volume and density of EAT in HIV-infected patients.Materials and MethodsThe CCTA and clinical data of 182 HIV-infected patients and 3528 non-HIV-infected controls,recruited between March 2017 and December 2020,were subjected to retrospective analysis.All HIV-positive and HIV-negative individuals were matched according to age(<5 years),gender,BMI(<0.5kg/m2)and traditional cardiovascular risk factors at a ratio of 1:1.Ultimately,there were 166 patients both in the HIV-positive group and the HIV-negative control group,according to certain inclusion and exclusion conditions.For all enrolled patients,perivascular FAI was examined in enhanced image.Coronary artery calcification score(CACS)and the volume and density of EAT were measured in unenhanced imaging.According to applicable conditions,the difference in CACS and the volume of EAT between the HIV-positive group and the non-HIV control group was analyzed by Wilcoxon rank-sum test.Perivascular FAI and the density of EAT,normally distributed,were analyzed by paired sample t test between the two groups.Cardiovascular risk was stratified by CACS in patients with HIV infection.Mann-Whitney U test analyzed the diversity of EAT volume between high-risk group(CACS>100)and low-risk group(CACS<100).The disparity of EAT density and perivascular FAI between the two groups was utilized by two-sample t-test.Factors independently associated with EAT volume,EAT density,and perivascular FAI were analyzed by multivariable backward stepwise linear regression analysis.ResultsThe volume of EAT in the HIV-positive group was greater than that in the non-HIV control group[157.3(203.3)cm3 Vs 115.2(78.2)cm3,P<0.001].In the HIV-positive group,the density of EAT was lower(-81.1±5.4 HU Vs-76.7±4.8 HU,P<0.001),the perivascular FAI of right coronary artery(RCA)was lower(-91.79±11.15 HU Vs-88.17±10.38 HU,P<0.001),the perivascular FAI of left anterior descending branch(LAD)was lower(-89.70±10.63 HU Vs-86.41±7.87 HU,P<0.001),and the perivascular FAI of left circumflex artery(LCX)was lower(-81.98±9.50 HU Vs-79,13±9.15 HU,P=0.002),compared to the non-HIV control group.The diversity of CACS between the two groups was not significant(P=0.111).In HIV-infected patients,compared to the CACS<100 group(n=133),the pericoronary FAI in the CACS ≥ 100 group(n=33)was higher(RCA:-85.08 ±11.74HU Vs-93.45±10.40HU,LAD:-83.82±10.64HU Vs-91.16±10.15HU,LCX:-74.28±9.76HU Vs-83.90± 8.44HU,all P<0.001).The distribution of the volume and density of EAT between the two groups were semblable(both P>0.05).The perivascular FAI of LAD was selected to represent the perivascular FAI of the entire coronary artery tree.In HIV-infected patients,a factor independently associated with the perivascular FAI of LAD was the density of EAT[β=0.326,95%confidence interval(CI)0.154 to 0.498,P<0.001].Only in univariate linear regression analyses,the durations of highly active antiretroviral therapy(HAART)and HIV viral load were significant(β=-0.185,95%CI-0.348 to-0.022,P=0.026;β=0.190,95%CI 0.001 to 0.379,P=0.049;respectively).The density of EAT was associated with plasma apolipoprotein B level(β=-0.182,95%CI-0.311 to-0.053,P=0.006),duration of HAART(β=-0.171,95%CI-0.324 to-0.018,P=0.029),and the perivascular FAI of LAD(β=0.330,95%CI 0.129 to 0.531,P=0.002).Factors independently associated with the volume of EAT included BMI(β=0.352,95%CI 0.192 to 0.513,P<0.001)and the density of EAT(β=-0.719,95%CI-0.903 to-0.535 P<0.001).ConclusionIn the HIV-positive group,the volume of EAT is larger,the density of EAT is lower,and the perivascular FAI in the proximal segment of coronary artery is lower,compared with the non-HIV control group.Among HIV infected patients,the pericoronary FAI is higher in the high-risk group than that in the low-risk group.Factors independently associated with EAT density include the plasma apolipoprotein B level,the duration of HAART,the volume of EAT and perivascular FAI in HIV infected patients.And BMI is independently associated with EAT volume.The volume and density of EAT and perivascular FAI may be the personalized evaluation index of cardiovascular risk in patients with HIV infection.