Introduction: The role of epicardial adipose tissue on coronary plaque vulnerability has been well establi-shed. However, the role of periplaque fat (PPF) has not been elucidated so far. Moreover, there is scarce data on the role of plaque location, in relation to peri-athero-matous adipose tissue on the vulnerability degree and morphology of coronary atherosclerotic lesions.
Objective: The aim of the study was to evaluate the in-fluence of PPF on coronary plaque vulnerability, in a comparative analysis between atherosclerotic lesions located in the right and left coronary arteries.
Methods: T his is an observational study which in-cluded 82 patients with stable CAD, who underwent 128-multislice CT coronary angiography, presented at least one coronary lesion with at least 50% degree of stenosis and exhibited ≥1 vulnerability markers (spotty calcifications – SC, Napkin ring sign – NRS, low atte-nuation plaque – LAP, positive remodeling – PR), in the respective coronary plaque. Image postprocessing was performed with the Syngo. via Frontier (Siemens) software and PPF was measured 10 mm around the analyzed VP. Based to the plaque location within the coronary tree, the study subjects were divided into group 1 (location of VP in the right coronary artery – RCA) – n=17; group 2 (location of VP in the left coro-nary artery – LCA) – n=65.
Results: Vulnerable plaques from the RCA were sig-nificantly longer (20.81 ± 6.45 vs. 17.37 ± 4.59 mm, p=0.02) and had a larger volume (269.3 ± 120.4 vs. 161.6 ± 89 mm3, p<0.0001) compared to the VPs from the LCA. Compared to group 2, coronary plaques in group 1 exhibited a higher vulnerability degree, illustrated by a larger non-calcified volume (232.5 ± 111 vs. 134.5 ± 83.29 mm3, p=0.0006), lipid-rich volume (19.4 ± 19.07 vs. 10.27 ± 17.08 mm3, p=0.0106), and fibro-fatty vo-lume (213 ± 101.3 vs. 124.2 ± 7.98 mm3, p=0.0009). The PPF was significantly larger in VPs from the RCA (0.92 ± 0.48 mm3 vs. 0. 57± 0.34 mm3, p=0.0041) com-pared to VPs located in the LCA. No differences were found regarding the total epicardial fat between the two groups (p=0.386).
Conclusions: Atherosclerotic plaques located in the RCA exhibited a higher number of vulnerability cha-racteristics compared to those located in the left co-ronary system and PPF was more pronounced in the regions surrounding VPs located within the RCA. This difference in vulnerability features could be explained not only by geometrical and hemodynamical characte-ristics of coronary circulation, but also by inflamma-tion-mediated alteration of endothelial shear stress triggered by release of inflammatory mediators from the local epicardial fat.