JACC. Cardiovascular imaging
October 16, 2026 · via Europe PMC
Patient-Level Perivascular Adipose Tissue Density Aggregation and Plaque Progression: Plaque-Free vs Plaque-Adjacent Segments.
Lee SE, Sung JM, Andreini D, +23 more, Chang HJ.
AI summary — for doctors, generated from the abstract only
Change in perivascular fat density, including in plaque-free segments, tracked coronary plaque progression, whereas baseline PVAT values did not.
What was studied
Analysis of 412 patients with baseline plaque from the PARADIGM serial coronary CTA registry (mean interval 3.2 years), comparing four patient-level PVAT aggregation approaches against annualized plaque volume progression.
Key findings
- Increases in proximal RCA, whole-coronary and plaque-free PVAT were each independently associated with total plaque volume progression
- For noncalcified plaque progression, only plaque-free PVAT change was significant
- No baseline PVAT measure was associated with progression, and the four measures did not differ significantly
Clinical relevance
Plaque-free PVAT may be a less confounded marker of pericoronary inflammation than measurements next to plaque.
Who should care
Limitations
Associations were with change in PVAT over time, not baseline values, limiting predictive use, and the registry sample is selected.
Do not yet use baseline PVAT for risk prediction; serial change in PVAT is of research interest only.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Perivascular adipose tissue (PVAT) density on coronary computed tomography angiography (CTA) reflects pericoronary inflammation, but measurements adjacent to existing plaques may be confounded by local inflammatory signaling from the plaque itself-a form of reverse causation. Whether systematically comparing patient-level PVAT aggregation approaches (including measurements restricted to plaque-free segments) can identify a more robust inflammatory biomarker has not been evaluated.
Objectives
The authors aimed to compare the predictive performance of 4 patient-level PVAT aggregation approaches for coronary plaque progression.
Methods
From the PARADIGM serial coronary CTA registry, 412 patients with baseline coronary plaque who underwent serial coronary CTA at identical tube voltages were included (mean age: 61.1 ± 9.3 years; 61.7% male; mean interval: 3.2 ± 1.2 years). Four patient-level PVAT measures were compared: proximal right coronary artery (pRCA), whole-coronary, plaque-free, and plaque PVAT. Multivariable regression models were constructed for annualized plaque volume (PV) progression with adjustment for clinical risk factors and imaging covariates.
Results
Annualized increases in pRCA PVAT (β = 0.804; P = 0.033), whole-coronary PVAT (β = 1.142; P = 0.022), and plaque-free PVAT (β = 1.419; P = 0.007) were each independently associated with total PV progression, whereas plaque PVAT did not reach significance (β = 0.755; P = 0.083). For noncalcified PV progression, plaque-free PVAT was the only significant measure (β = 1.086; P = 0.026). None of the 4 baseline PVAT measures were significantly associated with plaque progression (all P > 0.50). Pairwise comparisons revealed no significant differences among the 4 measures.
Conclusions
Changes in pRCA, whole-coronary, and plaque-free PVAT were each independently associated with total PV progression. For noncalcified PV progression, plaque-free PVAT change was the only significant measure. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411).
DOI
10.1016/j.jcmg.2026.08.018
PMID
42900033
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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