Plenary 2 Tuesday 01 June – Session 2

Atherosclerosis affecting fat: What can we learn by imaging perivascular adipose tissue? Charalambos Antoniades, Oxford, UK

Future CVD management: from gene to phenotype to treatment

Charalambos (Charis) Antoniades is a full Professor of Cardiovascular Medicine and Head of Acute Vascular Imaging Centre of the University of Oxford, the Deputy Head of the Division of Cardiovascular Medicine and director of the Oxford Academic cardiovascular CT programme (and Oxford Academic Cardiovascular CT Core Lab). He is also the Chair-Elect of the British Atherosclerosis Society. Professor Antoniades undertook a PhD into the genetics of premature myocardial infarction. His current research is focused on the crosstalk between adipose tissue and the cardiovascular system, with specific interest in non-invasive imaging of inflammation. He directs the Oxford Heart Vessels and Fat programme, and coordinates large national flagship programmes (such as the UK C19-CRC) and international multicentre studies (e.g. ORFAN study). His research has led to the development of novel imaging biomarkers using computed tomography, with a major role in cardiovascular risk prognosis. He was awarded the Outstanding Achievement Award of the basic Cardiovascular Science Council of the European Society of Cardiology in 2016, and a National clinical excellence award in 2020. He is one of the founders of the Scientists of Tomorrow of the European Society of Cardiology and vice chair of the Marie Curie Fellowships panel of the European Commission.

The advent of highly efficacious – yet costly – therapeutics highlights the need for their judicious use in individuals likely to benefit most. Imaging modalities may offer a feasible approach to the selective use of such treatments. Given that atherosclerosis is a chronic inflammatory disease, understanding the underlining inflammatory mechanisms has led to technological advances in the noninvasive detection of coronary artery inflammation.

A key focus has been the perivascular adipose tissue surrounding the human coronary arteries, given evidence of crosstalk between this and the associated vasculature.  In this bidirectional dynamic interplay, the perivascular adipose tissue secretes numerous cytokines that influence the vascular wall, but it also senses signals from the vascular wall which drive changes in its morphology and secretory profile. This sensing ability suggests potential for non-invasive detection of coronary inflammation. Indeed, vascular inflammation alters the composition of the perivascular adipose tissue from lipid to aqueous phase, and the use of computed tomography has shown a gradient of increasing attenuation closer to the inflamed coronary artery wall.  Artificial intelligence-based image analysis has enabled accurate and reproducible measurement of such attenuation maps, based on measures such as the Fat Attenuation Index, which provides a gauge of weighted attenuation shifts within the perivascular adipose tissue.  This index offers predictive value in individuals with and without high-risk plaque features, may guide medical management in individuals undergo coronary imaging, and help to modify clinical decisions regarding coronary revascularisation in those with stable ischaemic heart disease. Thus, these advances suggest important diagnostic and prognostic implications for the future.

Recent references

Antoniades C, Antonopoulos AS, Deanfield J. Imaging residual inflammatory cardiovascular risk. Eur Heart J 2020;41:748-58.

Oikonomou EK, Desai MY, Marwan M, Kotanidis CP, Antonopoulos AS, Schottlander D, Channon KM, Neubauer S, Achenbach S, Antoniades C. Perivascular fat attenuation index stratifies cardiac risk associated with high-risk plaques in the CRISP-CT Study. J Am Coll Cardiol 2020;76:755-7.

Abdelrahman KM, Chen MY, Dey AK, Virmani R, Finn AV, Khamis RY, Choi AD, Min JK, Williams MC, Buckler AJ, Taylor CA, Rogers C, Samady H, Antoniades C, Shaw LJ, Budoff MJ, Hoffmann U, Blankstein R, Narula J, Mehta NN. Coronary computed tomography angiography from clinical uses to emerging technologies: JACC State-of-the-Art Review. J Am Coll Cardiol 2020;76:1226-43.

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