Pericoronary fat attenuation on coronary ct identifies persistent vascular inflammation after chest radiotherapy in cancer survivors

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ID: 323321
2026
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Ranked #223 of 282 articles by views in European heart journal supplements : journal of the European Society of Cardiology

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Abstract
Abstract Background Cancer survivors remain at increased risk of coronary events even when obstructive coronary disease is mild. A key gap in routine care is detecting ongoing vascular inflammation, particularly after chest radiotherapy. Pericoronary adipose tissue attenuation on coronary computed tomography angiography (CCTA) is a practical imaging marker of coronary inflammation. Purpose To determine whether chest radiotherapy is associated with higher pericoronary fat attenuation on CCTA, and whether this inflammatory signal relates to high-risk plaque phenotype. Methods We retrospectively analyzed consecutive adults undergoing clinically indicated CCTA between 2021–2025. Cancer survivors were stratified into prior chest radiotherapy versus no radiotherapy and compared with age- and sex-matched non-cancer controls. Pericoronary fat attenuation was measured as mean attenuation (Hounsfield units) around the proximal right coronary artery. Coronary stenosis severity (CAD-RADS) and high-risk plaque features (low attenuation plaque, positive remodeling, spotty calcification, napkin-ring sign) were recorded. A subset with complete blood count within ±30 days was used to examine associations with neutrophil-to-lymphocyte ratio (NLR). Results A total of 318 patients were included (198 cancer survivors, 120 controls; mean age 53±11 years; 54% female). Among survivors, 76 (38%) had prior chest radiotherapy. Obstructive coronary disease was uncommon and comparable across groups (≥50% stenosis: 9% radiotherapy vs 7% no radiotherapy vs 8% controls; p=0.81). Pericoronary fat attenuation was higher (less negative) in radiotherapy survivors compared with non-radiotherapy survivors and controls (−69±7 vs −73±6 vs −75±6 HU; p<0.001). High-risk plaque features were more frequent in the radiotherapy group (21% vs 13% vs 10%; p=0.03). After adjustment for traditional risk factors, chest radiotherapy remained independently associated with higher pericoronary fat attenuation (β=+3.1 HU, p=0.002). In the CBC subset (n=210), higher NLR showed a modest association with higher pericoronary fat attenuation (r=0.24, p=0.01). Conclusion Chest radiotherapy is associated with a measurable CCTA inflammatory signature using pericoronary fat attenuation, even when stenosis severity is similar. This pragmatic CT-based marker may help identify cancer survivors with persistent vascular inflammation and higher plaque vulnerability, supporting more targeted preventive strategies.
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Authors A Albulushi, A Tawfek, T D De Silva, M Al-Sarmi
Journal European heart journal supplements : journal of the European Society of Cardiology
Year 2026
DOI
10.1093/eurheartjsupp/suag097.040
URL
https://doi.org/10.1093/eurheartjsupp/suag097.040
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