Phenotyping Atherosclerotic Plaque and Perivascular Adipose Tissue: Signalling Pathways and Clinical Biomarkers in Atherosclerosis

Kajetan Grodecki,Jolien Geers,Jacek Kwiecinski,Andrew Lin,Leandro Slipczuk,Piotr J. Slomka,Marc R. Dweck,Nitesh Nerlekar,Michelle C. Williams,Daniel Berman,Thomas Marwick,David E. Newby,Damini Dey

Nature Reviews Cardiology（2025）

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Abstract

Computed tomography coronary angiography provides a non-invasive evaluation of coronary artery disease that includes phenotyping of atherosclerotic plaques and the surrounding perivascular adipose tissue (PVAT). Image analysis techniques have been developed to quantify atherosclerotic plaque burden and morphology as well as the associated PVAT attenuation, and emerging radiomic approaches can add further contextual information. PVAT attenuation might provide a novel measure of vascular health that could be indicative of the pathogenetic processes implicated in atherosclerosis such as inflammation, fibrosis or increased vascularity. Bidirectional signalling between the coronary artery and adjacent PVAT has been hypothesized to contribute to coronary artery disease progression and provide a potential novel measure of the risk of future cardiovascular events. However, despite the development of more advanced radiomic and artificial intelligence-based algorithms, studies involving large datasets suggest that the measurement of PVAT attenuation contributes only modest additional predictive discrimination to standard cardiovascular risk scores. In this Review, we explore the pathobiology of coronary atherosclerotic plaques and PVAT, describe their phenotyping with computed tomography coronary angiography, and discuss potential future applications in clinical risk prediction and patient management. In this Review, Dey and colleagues explore the pathobiology of coronary atherosclerotic plaques and perivascular adipose tissue, describe their phenotyping with computed tomography coronary angiography, and discuss potential future applications in clinical risk prediction and patient management.

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【要点】：本文综述了冠状动脉粥样硬化斑块和周围脂肪组织的病理生物学，探讨了计算机断层扫描冠状动脉造影在表型分析中的应用，及其在临床风险预测和管理中的潜在价值。

【方法】：作者通过分析已有的图像处理技术和放射组学方法，研究了粥样硬化斑块和周围脂肪组织（PVAT）的表型特征。

【实验】：本文未提供具体实验描述，但提及了使用计算机断层扫描冠状动脉造影技术，并对相关数据集进行了分析，得出PVAT衰减作为血管健康的潜在新型指标，对心血管事件风险预测的有限贡献。