Comprehensive coronary computed tomography angiography assessment in high-altitude diabetic populations: integrating plaque characteristics, pericoronary inflammation, and coronary function
- 1West China Hospital, Sichuan University , ,
- 2BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai , , ,
Abstract
Background: Coronary computed tomography angiography (CCTA) provides complementary anatomical, inflammatory, calcific, and functional biomarkers, but their interpretation under chronic high-altitude exposure remains uncertain. We characterized CCTA phenotypes according to altitude and type 2 diabetes and explored associations with major adverse cardiovascular events (MACE).
Methods: This retrospective matched cohort with prospective outcome ascertainment included adults undergoing clinically indicated CCTA for suspected coronary artery disease. Participants were classified by high-altitude residence (≥2,500 m for ≥5 years) or low-altitude residence (<500 m) and by diabetes status, forming four groups. Propensity score matching was performed separately within diabetes strata using age, sex, body mass index, and hypertension, yielding 174 participants in 87 matched pairs. CCTA assessment included pericoronary adipose tissue (PCAT) attenuation, plaque characteristics, coronary artery calcium (CAC), coronary stenosis, and vessel-specific CT-derived fractional flow reserve (CT-FFR). Primary models evaluated altitude, diabetes, and their interaction with adjustment for age, sex, body mass index, and hypertension. Associations with MACE were explored using univariable Cox models among participants with follow-up.
Results: In primary covariate-adjusted analyses, diabetes was associated with higher PCAT attenuation, CAC, total plaque volume, plaque burden, and maximum stenosis and with lower left anterior descending (LAD) CT-FFR (all q ≤ 0.018). Compared with the low-altitude Han group, the high-altitude Tibetan group had higher LAD and right coronary artery CT-FFR and lower CAC and plaque burden (all q ≤ 0.037). Among 13 interaction tests, only the altitude × diabetes interaction for LAD-PCAT remained significant after false discovery rate correction (−6.62 HU; 95% CI, −10.32 to −2.91; raw P < 0.001; q = 0.008). Among 119 participants with follow-up, 20 MACE occurred over a median of 28 months. Exploratory univariable analyses showed large but imprecise associations of diabetes and high-risk plaque with MACE, whereas altitude was not statistically associated with MACE ( P = 0.557).
Conclusion: Diabetes was associated with a more adverse coronary CCTA phenotype, whereas the high-altitude Tibetan group showed lower CAC and plaque burden and higher vessel-specific CT-FFR than the low-altitude Han group. The association between diabetes and LAD-PCAT attenuation differed between these groups. These findings warrant validation in larger, ethnically comparable longitudinal cohorts.
Related
- Incremental diagnostic value of coronary CT angiography-derived pericoronary adipose tissue radiomics for identifying hemodynamically significant coronary stenosis
- Computed Tomography Angiography-Derived Pericoronary Fat Attenuation Index and AI-Based Cardiovascular Risk Score as a Proposed New Pathway in a Rapid Access Chest Pain Clinic: A Single-Centre Retrospective Registry Study
- Age-Related Hypofluorescent Indocyanine Green Angiography Spots : Prevalence, Characteristics, and Associated Features in Age-Related Macular Degeneration
- Quantification of plaque and detection of high-risk plaque characteristics based on coronary computed tomography angiography: comparison between superresolution deep learning reconstruction and hybrid iterative reconstruction
- Application of a multimodal model integrating optical coherence tomography angiography (OCTA) and radiomics for the identification of high-risk Nonarteritic anterior ischaemic optic neuropathy (NAION) populations and for distinguishing its acute phase.
BibTeX
@article{fang2026comprehensive,
title = {{Comprehensive coronary computed tomography angiography assessment in high-altitude diabetic populations: integrating plaque characteristics, pericoronary inflammation, and coronary function}},
author = {Xin Fang and Shuang Li and Zhetao Wang and Junyan Zhang and Jia Song and Bing Wu and Kang Li and Kaiyue Diao},
journal = {Frontiers in cardiovascular medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1886360},
url = {https://europepmc.org/article/PMC/PMC13690624},
note = {CC BY},
}
RIS
TY - JOUR
TI - Comprehensive coronary computed tomography angiography assessment in high-altitude diabetic populations: integrating plaque characteristics, pericoronary inflammation, and coronary function
AU - Xin Fang
AU - Shuang Li
AU - Zhetao Wang
AU - Junyan Zhang
AU - Jia Song
AU - Bing Wu
AU - Kang Li
AU - Kaiyue Diao
PY - 2026
DA - 2026/10/09
JO - Frontiers in cardiovascular medicine
DO - 10.3389/fcvm.2026.1886360
UR - https://europepmc.org/article/PMC/PMC13690624
AB - Background: Coronary computed tomography angiography (CCTA) provides complementary anatomical, inflammatory, calcific, and functional biomarkers, but their interpretation under chronic high-altitude exposure remains uncertain. We characterized CCTA phenotypes according to altitude and type 2 diabetes and explored associations with major adverse cardiovascular events (MACE). Methods: This retrospective matched cohort with prospective outcome ascertainment included adults undergoing clinically indicated CCTA for suspected coronary artery disease. Participants were classified by high-altitude residence (≥2,500 m for ≥5 years) or low-altitude residence (<500 m) and by diabetes status, forming four groups. Propensity score matching was performed separately within diabetes strata using age, sex, body mass index, and hypertension, yielding 174 participants in 87 matched pairs. CCTA assessment included pericoronary adipose tissue (PCAT) attenuation, plaque characteristics, coronary artery calcium (CAC), coronary stenosis, and vessel-specific CT-derived fractional flow reserve (CT-FFR). Primary models evaluated altitude, diabetes, and their interaction with adjustment for age, sex, body mass index, and hypertension. Associations with MACE were explored using univariable Cox models among participants with follow-up. Results: In primary covariate-adjusted analyses, diabetes was associated with higher PCAT attenuation, CAC, total plaque volume, plaque burden, and maximum stenosis and with lower left anterior descending (LAD) CT-FFR (all q ≤ 0.018). Compared with the low-altitude Han group, the high-altitude Tibetan group had higher LAD and right coronary artery CT-FFR and lower CAC and plaque burden (all q ≤ 0.037). Among 13 interaction tests, only the altitude × diabetes interaction for LAD-PCAT remained significant after false discovery rate correction (−6.62 HU; 95% CI, −10.32 to −2.91; raw P < 0.001; q = 0.008). Among 119 participants with follow-up, 20 MACE occurred over a median of 28 months. Exploratory univariable analyses showed large but imprecise associations of diabetes and high-risk plaque with MACE, whereas altitude was not statistically associated with MACE ( P = 0.557). Conclusion: Diabetes was associated with a more adverse coronary CCTA phenotype, whereas the high-altitude Tibetan group showed lower CAC and plaque burden and higher vessel-specific CT-FFR than the low-altitude Han group. The association between diabetes and LAD-PCAT attenuation differed between these groups. These findings warrant validation in larger, ethnically comparable longitudinal cohorts.
SN - 2297-055X
ER -