Study On The Characteristics Of Peri-coronary Adipose Tissue And Its Assessment Of Disease Risk And Prognosis In Patients With Hypertension

Objectives:Quantitative detection of peri-coronary adipose tissue volume(PCATV)and fat attenuation index(FAI)based on coronary computed tomography(CCTA),the characteristics of PCATV and FAI in hypertension(HT)patients and HT combining with coronary atherosclerosis(CAS)were analyzed,the performance of PCATV and FAI in HT patients with different antihypertensive treatment effects were also observed,so as to explore the value of PCAT evaluating the disease risk,development and prognosis of HT patients.Methods:From January 2021 to April 2022,406 patients clinically diagnosed as HT in this hospital were retrospectively collected as the observation group and 297 non-hypertensive patients during the same period were selected as controls.All of them have received CCTA examination.The PCATV and FAI of three main coronary arteries proximal portion(within 40mm)on CCTA were measured semi-automatically by Sukun image post-processing software.According to the presence of CAS in the coronary arteries,patients were divided into the group with CAS or without CAS.The HT group was divided into different blood pressure grades,duration of disease,gender,BMI and age.The differences of PCATV and FAI among those subgroups were compared to explore the value of PCAT evaluating the risk and the progression of disease in HT patients.The influencing factors of PCATV and FAI were analyzed by multifactor linear analysis,the independent risk factors of CAS lesions in HT patients were determined by multivariate regression analysis,and the diagnostic efficacy was calculated.HT patients who had received clinical antihypertensive treatment were divided into a well-controlled group and a poorly controlled group.The differences of PCATV and FAI between the two groups were compared,and the independent factors affecting the efficacy of hypotension in patients were also analyzed by binary Logistic regression to preliminarily discussed the role of PCAT in evaluating the efficacy and prognosis of HT patients.Results:(1)Serum creatinine in HT group was higher than in controls(P<0.05).PCATV of three coronary arteries were decreased and FAI were increased in HT compared to controls(P<0.05).Comparing with HT grade 1 and grade 2,RCA-PCATV in grade 3 decreased(P<0.05),and FAI of three coronary arteries increased(P<0.05),while were not significantly different between grade 1 and grade 2 groups(P>0.05).LCX-PCATV,LAD-FAI and RCA-FAI in patients with disease duration<5 years group were less than those with>10 years group(P<0.05).RCA-PCATV of female was increased than male(P<0.05),while FAI of three coronary arteries were decreased(P<0.05).LCX-PCATV,LAD-FAI and RCA-FAI were increased in overweight patients compared with non-overweight patients(P<0.05).LCX-PCATV and RCA-PCATV of ≥60 years old were higher than those of<60 years old(P<0.05).Multifactor linear regression showed that the independent factors of LAD-PCATV were blood pressure grade and triglyceride(P<0.05).The independent influencing factors of LCX-PCATV were duration of disease and blood pressure grade(P<0.05).The independent influencing factors of RCA-PCARV,LAD-FAI and LCX-FAI were the same,which were gender and blood pressure grade(P<0.05).RCA-FAI were BMI,gender,duration of disease and blood pressure grade(P<0.05).(2)HT combined CAS patients LAD-FAI[-81(-86,-76)HU],RCA-FAI[-80(-86,-75)HU]were higher than those without CAS[-83(-87,-79)HU,-84(-89,-78)HU;P<0.001],while there was no significant difference in remaining PCAT indicators in HT patients combined with CAS and those without.Multivariate regression analysis established age,creatinine,and RCA-FAI as independent risk factors for the development of CAS in HT patients.The ROC curve showed the AUC value of age index evaluating the presence of CAS in HT patients was 0.653,and the threshold value was 60.5 years old with specificity about 64.3%and sensitivity 62.3%.The AUC of serum creatinine was 0.601(threshold value:75.5μmol/L),and with a specificity 57.4%and sensitivity 63.2%.The RCA-FAI respectively was 0.621(threshold value:-77.5 HU),and with specificity 44.0%and sensitivity 72.9%.The AUC value of combining with three index was 0.709,the specificity was 76.0%,and the sensitivity was 58.5%.There were no significant differences in PCATV and FAI among the three coronary arteries with different plaque properties(P>0.05).The RCA-FAI of significant stenosis in HT patients with CAS was higher than those<50%stenosis(P=0.01),and RCA-FAI has a negative effect on degree of coronary artery stenosis(r=0.165,P=0.006).LCX-PCATV and RCA-PCATV in patients with more than 2 arteries were lower than ≤2(P<0.05),while the former’s LCX-FAI and RCA-FAI values were greater than the latter’s(P<0.05).LCX-PCATV、RCA-PCATV have a negative effect on the number of lesions,while FAI of three coronary arteries have a positive effect。(3)FAI of three coronary arteries in poorly controlled group[-78.65±5.76 HU;-75(-79,-72)HU;-76.25±6.78 HU]were increased compared with in well controlled group[LAD-FAI:-82.54±6.50 HU;LCX-FAI:-80(-84,-75.5)HU;RCA-FAI:-82.26±5.94 HU;P<0.05],while PCAV of three coronary arteries had no difference among two groups.Multivariate regression analysis showed that blood pressure grade(OR=0.293;95%CI:0.121～0.711),RCA-FAI(OR=1.115;95%CI:1.025～1.213)were independent risk factors for therapeutic effect in HT patients.Conclusions:(1)FAI increases with the progression of hypertensive patients,and PCATV decreases,which is related to traditional risk factors for hypertension.(2)RCA-FAI was positively correlated with the stenosis degree and numbers of CAS lesions.RCA-FAI,age,and serum creatinine were independent risk factors for the presence of CAS in HT patients.(3)blood pressure grade and RCA-FAI were independent risk factors for therapeutic effect in HT patients,and RCA-FAI could initially assess the effect of HT antihypertensive therapy and those prognosis.