Su KX, Jiang SY, Pang CF, Yang F, Tang YQ, Li XG, He WF, Li R. Coronary computed tomography angiography adipose tissue attenuation in diabetic patients with myocardial ischemia and non-obstructive coronary arteries. World J Cardiol 2026; 18(1): 112857 [DOI: 10.4330/wjc.v18.i1.112857]
Corresponding Author of This Article
Rui Li, Professor, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, Maoyuan South Road, Shunqing District, Nanchong 637000, Sichuan Province, China. ddtwg_nsmc@163.com
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Cardiac & Cardiovascular Systems
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 26, 2026 (publication date) through Jan 15, 2026
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World Journal of Cardiology
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1949-8462
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Su KX, Jiang SY, Pang CF, Yang F, Tang YQ, Li XG, He WF, Li R. Coronary computed tomography angiography adipose tissue attenuation in diabetic patients with myocardial ischemia and non-obstructive coronary arteries. World J Cardiol 2026; 18(1): 112857 [DOI: 10.4330/wjc.v18.i1.112857]
World J Cardiol. Jan 26, 2026; 18(1): 112857 Published online Jan 26, 2026. doi: 10.4330/wjc.v18.i1.112857
Coronary computed tomography angiography adipose tissue attenuation in diabetic patients with myocardial ischemia and non-obstructive coronary arteries
Kai-Xiang Su, Si-Yu Jiang, Cai-Feng Pang, Fan Yang, Yu-Qing Tang, Xiao-Gang Li, Wen-Feng He, Rui Li
Kai-Xiang Su, Si-Yu Jiang, Cai-Feng Pang, Fan Yang, Yu-Qing Tang, Rui Li, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, Nanchong 637000, Sichuan Province, China
Xiao-Gang Li, Department of Radiology, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
Wen-Feng He, Department of Cardiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Co-first authors: Kai-Xiang Su and Si-Yu Jiang.
Co-corresponding authors: Wen-Feng He and Rui Li.
Author contributions: Su KX and Jiang SY wrote the main manuscript text, and they contributed equally to this manuscript and are co-first authors; Pang CF and Yang F were responsible for data acquisition and analysis; Tang YQ was responsible for creating the figures; Li XG provided the software utilized in the creation of this work; He WF and Li R reviewed the manuscript, and they contributed equally to this manuscript and are co-corresponding authors. All authors read and approved the manuscript.
Supported by Health Commission of Sichuan Province Medical Science and Technology Program, China, No. 24WXXT10; and Primary Health Development Research Center of Sichuan Province Program, No. SWFZ23-Y-36.
Institutional review board statement: The present study was conducted in accordance with the guidelines stipulated in Declaration of Helsinki and approved by the Ethics Committee of the Affiliated Hospital of North Sichuan Medical College (Approval No. 2024ER648-1).
Informed consent statement: The requirement for obtaining informed consent from the patients was waived due to the retrospective nature of the present study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rui Li, Professor, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, Maoyuan South Road, Shunqing District, Nanchong 637000, Sichuan Province, China. ddtwg_nsmc@163.com
Received: August 8, 2025 Revised: September 9, 2025 Accepted: November 25, 2025 Published online: January 26, 2026 Processing time: 160 Days and 21.7 Hours
Abstract
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.
Core Tip: This study reveals significantly increased pericoronary adipose tissue attenuation (PCATa) in the proximal segments of the left anterior descending, left circumflex, and right coronary arteries in patients with type 2 diabetes mellitus, particularly those with ischemia with non-obstructive coronary arteries (INOCA). PCATa serves as an independent imaging biomarker for identifying INOCA and demonstrated superior diagnostic performance compared with conventional clinical indicators. The combination of PCATa and clinical parameters further improves diagnostic accuracy. These results highlight the potential value of coronary computed tomography angiography-derived PCATa in early risk stratification and noninvasive identification of INOCA in patients with type 2 diabetes mellitus.
