Coronary computed tomography angiography adipose tissue attenuation in diabetic patients with myocardial ischemia and non-obstructive coronary arteries.

BACKGROUND: Type 2 diabetes mellitus (T2DM) substantially increases the risk of cardiovascular disease, including ischemia with non-obstructive coronary artery disease (INOCA). Coronary computed tomography angiography (CCTA) enables early detection of coronary abnormalities; however, it may fail to identify INOCA due to the absence of overt stenosis. Pericoronary adipose tissue attenuation (PCATa) values derived from CCTA in the proximal segments of the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) serve as effective imaging biomarkers for coronary inflammation. However, its clinical use for identifying INOCA in patients with T2DM remains poorly defined. AIM: To investigate PCATa differences and their diagnostic value for identifying INOCA in patients with T2DM. METHODS: This retrospective study involved 228 T2DM patients underwent CCTA and 120 healthy individuals. The mean PCATa values within the proximal segments of the three major coronary arteries were compared between groups. Further subgroup analysis was performed to assess the differences in PCTAa and clinical characteristics between T2DM patients with and without INOCA. Logistic regression analysis was conducted to identify the independent risk factors for INOCA, and the receiver operating characteristic curves were generated to evaluate the diagnostic performance of each indicator. RESULTS: Compared with controls, T2DM patients exhibited significantly higher PCATa values in all three major coronary arteries. Among them, those with concomitant INOCA showed further increases compared to those without INOCA (all P < 0.05). Multivariate logistic regression identified age; female sex; elevated glycated hemoglobin; and increased PCATa in the LAD, LCX, and RCA as independent risk factors for INOCA. Receiver operating characteristic analysis showed good diagnostic performance for PCATa [LAD area under the curve (AUC) = 0.809; LCX AUC = 0.777; RCA AUC = 0.758], outperforming traditional clinical indicators (AUC = 0.731). Combining PCATa with clinical parameters yielded the highest diagnostic accuracy (LAD AUC = 0.851; LCX AUC = 0.842; RCA AUC = 0.841). CONCLUSION: Elevated proximal PCATa is an independent risk factor for INOCA in T2DM. Combining PCATa with clinical data improves diagnostic performance in this population.