TOPLINE:

Pericoronary adipose tissue (PCAT) attenuation measured using coronary CT angiography (CCTA) was significantly correlated with levels of circulating inflammatory biomarkers interleukin-6 (IL-6) and TNF alpha, with chronic stress moderating the relationship between IL-6 and PCAT attenuation. PCAT attenuation was further correlated with the total plaque volume (TPV), a study showed.

METHODOLOGY:

• Researchers analysed data of 98 patients without known coronary artery disease (CAD) and with a very low to moderate pretest probability of CAD who were referred for CCTA at a hospital in Zürich between 2020 and 2023.
• Laboratory tests included hair cortisol concentration measurement, vital exhaustion questionnaire assessment, and analysis of IL-6 and TNF alpha levels.
• Experienced cardiac imaging readers evaluated CCTA scans using the semiautomated plaque analysis software, focusing on the proximal 10-50 mm of the right coronary artery, with PCAT being defined as tissue voxels between -190 and -30 Hounsfield units (HU).
• Researchers assessed the potential association between levels of IL-6 and TNF alpha and CT-derived PCAT attenuation and tested the potential relationship between PCAT attenuation and TPV, high-risk features, and stenosis severity.

TAKEAWAY:

• PCAT attenuation showed significant associations with levels of IL-6 (mean difference, 1.05; P = .014) and TNF alpha (mean difference, 0.60; P = .027).
• A 1 HU higher PCAT attenuation corresponded to a 3.51 mm³ greater TPV (P = .048); however, no direct effect of chronic stress was observed on TPV (mean difference, -0.12; P = .962).
• No significant association was found between PCAT attenuation and vulnerable plaque features, stenosis, or the presence of CAD (odds ratio, 1.03; P = .300).
• Hair cortisol concentration (P = .019) and vital exhaustion (P = .024) moderated the relationship between IL-6 and PCAT attenuation, highlighting CT’s sensitivity to stress-inflamed vessels.

IN PRACTICE:

“The current study confirms the PCAT attenuation as novel inflammatory imaging biomarker, which seems to be correlated with pro-inflammatory cytokines and TPV, and moderated by chronic stress. These findings may imply that PCAT attenuation presents a modifiable risk parameter for the development of atherosclerotic plaques and cardiovascular disease,” the authors wrote. “PCAT attenuation could be used as a specific marker of vascular inflammation to test the effects of novel therapeutics and psychosocial interventions,” they added.

SOURCE:

This study was led by Tobia Albertini and Marc Dörner, University Hospital Zürich, Zürich, Switzerland. It was published online on August 31, 2025, in the European Heart Journal – Cardiovascular Imaging.

LIMITATIONS:

The cross-sectional nature of the study limited causal inference. Being conducted at a single centre restricted generalisability, and the inclusion of primarily low-risk CAD patients may have excluded those with more severe inflammation, potentially explaining the relatively low IL-6 and TNF alpha levels observed. The analysis focused solely on the right coronary artery due to technical robustness. Additionally, TPV was not indexed to the lumen volume, which may have affected the assessment of sex and body size effects.

DISCLOSURES:

One author reported receiving grant support from the Swiss Heart Foundation for this study. The University Hospital Zürich reported holding a research agreement with GE Healthcare.