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State-of-the-art review article. Atherosclerosis affecting fat: What can we learn by imaging perivascular adipose tissue?

Lookup NU author(s): Dr Chris Kotanidis



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2019 [The Author/The Authors]. Perivascular adipose tissue (PVAT) surrounding the human coronary arteries, secretes a wide range of adipocytokines affecting the biology of the adjacent vascular wall in a paracrine way. However, we have recently found that PVAT also behaves as a sensor of signals coming from the vascular wall, to which it reacts by changing its morphology and secretory profile. Indeed, vascular inflammation, a key feature of vascular disease pathogenesis, leads to the release of inflammatory signals that disseminate into local fat, inducing local lipolysis and inhibiting adipogenesis. This ability of PVAT to sense inflammatory signals from the vascular wall, can be used as a “thermometer” of the vascular wall, allowing for non-invasive detection of coronary inflammation. Vascular inflammation induces a shift of PVAT's composition from lipid to aqueous phase, resulting into increased computed tomography (CT) attenuation around the inflamed artery, forming a gradient with increasing attenuation closer to the inflamed coronary artery wall. These spatial changes in PVAT's attenuation are easily detected around culprit lesions during acute coronary syndromes. A new biomarker designed to captured these spatial changes in PVAT's attenuation around the human coronary arteries, the Fat Attenuation Index (FAI), has additional predictive value in stable patients for cardiac mortality and non-fatal heart attacks, above the prediction provided by the current state of the art that includes risk factors, calcium score and presence of high risk plaque features. The use of perivascular FAI in clinical practice may change the way we interpret cardiovascular CT angiography, as it is applicable to any coronary CT angiogram, and it offers dynamic information about the inflammatory burden of the coronary arteries, providing potential guidance for preventive measures and invasive treatments.

Publication metadata

Author(s): Antoniades C, Kotanidis CP, Berman DS

Publication type: Review

Publication status: Published

Journal: Journal of Cardiovascular Computed Tomography

Year: 2019

Volume: 13

Issue: 5

Pages: 288-296

Print publication date: 01/09/2019

Online publication date: 29/03/2019

Acceptance date: 25/03/2019

ISSN (print): 1934-5925

ISSN (electronic): 1876-861X

Publisher: Elsevier Inc.


DOI: 10.1016/j.jcct.2019.03.006

PubMed id: 30952610