DETERMINATION OF PERIVASCULAR FAT DENSITY INDEX BY CT CORONARY

ANGIOGRAPHY IN RHEUMATOID ARTHRITIS

 

Gaman S.A.¹, Fomicheva O.A.¹, Shingareeva F.F.¹, Belkind M.B.¹,

Karpov Y.A.¹, Ternovoy S.K.^1,2

 

1 - E.A. Chazov National Medical Research Centre of Cardiology.

2 -  Sechenov University. Moscow, Russia.

R

heumatoid arthritis (RA) is an autoimmune rheumatic disease characterized by progressive joint destruction and internal organ damage. Inflammation in the vascular wall characteristic of RA sets the stage for the development and progression of atherosclerotic arterial lesions. Epicardial adipose tissue and secreted cytokines are potential factors in the development of atherosclerosis in coronary arteries.

Purpose. To determine the value of perivascular fat index of coronary arteries in the patients with rheumatoid arthritis in comparison the patients with coronary heart disease without systemic diseases.

Materials and methods. Seventy-two patients, mean age 62 years, were examined. The group with rheumatoid arthritis included 49 patients (39 women), some of them had coronary artery disease (CAD) (n=22). The comparison group included 23 patients (10 women) diagnosed with CAD, without rheumatoid arthritis. The studied groups of patients were comparable in terms of age, body mass index, presence of arterial hypertension. In the rheumatoid arthritis group female gender, level of the rate of erythrocyte sedimentation prevailed. The groups did not differ in the levels of lipid parameters of high-sensitivity C-reactive protein.

Computer tomography (CT) coronary angiography was performed in all patients. CT images were processed on Vitrea Workstation using Vitrea Advanced software package. A technique of perivascular fat index (PVFI) determination at the level of the proximal segment of the right coronary artery was developed using software to analyze atherosclerotic plaque composition.

Results. The perivascular fat index was determined in patients with rheumatoid arthritis and CAD without systemic diseases. The prevalence of this index was shown in moderate and low rheumatoid arthritis patients on adequate antirheumatic therapy compared to CAD patients without systemic diseases (-66.5 [-47;-85] HU, -91.1 [-101;-85] HU, respectively, p<0.05). perivascular fat index did not differ in rheumatoid arthritis patients, depending on the presence/absence of CAD, and was higher in the rheumatoid arthritis with CAD group compared to CAD patients without rheumatoid arthritis (-68 [-48; 87] HU and -91.1 [-101;-85] HU, respectively, p<0.0.5)

Comparison of major cardiovascular risk  factors showed  prevalence of  inflammatory parame-

 

ters (ESR, hsCRP) in patients with rheumatoid arthritis with CAD compared to CAD patients without systemic disease [17.5 vs. 6 mm/hour, and 3.8 vs. 1.2 mg/dL, p<0.0.5].

Discussion. In the present study, we applied and developed the technique of perivascular fat index determination by CT coronary angiography in patients with rheumatoid arthritis with different degrees of coronary artery disease and patients with CАD without rheumatoid arthritis. It should be noted that the increased density of perivascular adipose tissue in patients with rheumatoid arthritis compared with CAD patients without systemic diseases confirms the concept of the contribution of immune inflammation in patients to the development of coronary atherosclerosis in the absence of differences in other factors of CAD.

Conclusion. The obtained data confirm the main role of inflammatory mechanisms in the development of atherosclerosis in rheumatoid arthritis. The developed method for determining the perivascular fat density index is a tool for visualizing inflammation in rheumatoid arthritis and can be used as an additional marker of cardiovascular risk in patients with systemic diseases. The prevalence of the perivascular fat density index in patients with rheumatoid arthritis, moderate and low activity, who are on adequate antirheumatic therapy, compared with patients with coronary heart disease without systemic diseases is shown.

 

Keywords: rheumatoid arthritis, atherosclerosis, perivascular fatty tissue of coronary arteries, cardiovascular diseases, CT-coronarography.

 

Corresponding author: Gaman S.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Gaman S.A., Fomicheva O.A., Shingareeva F.F., Belkind M.B., Karpov Y.A., Ternovoy S.K. Determination of perivascular fat density index by CT coronary angiography in rheumatoid arthritis. REJR 2025; 15(1):73-83. DOI: 10.21569/2222-7415-2025-15-1-73-83.

Received:        26.12.24 Accepted:       27.01.25