https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland; 2Evangelische Krankenhaus Oberhausen GmbH Klinik für Kardiologie und Angiologie Oberhausen, Deutschland; 3Universitätsklinikum Essen Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie Essen, Deutschland
Background: The napkin-ring sign (NRS) is a well-established marker of high-risk coronary plaques (HRP). We aimed to evaluate, how lipid-lowering therapy associated with its prevalence and the interplay with epicardial as well as peri-coronary adipose tissue (EAT and PCAT) volume and attenuation.
Methods: In this retrospective analysis, patients undergoing coronary CT angiography were included. Prevalence of at least one plaque with Napkin-Ring Sign was evaluated within the complete coronary tree. EAT as well as PCAT and attenuation were manually assessed from available CT images. Existing statin therapy was assessed from hospital records. Logistic regression was applied to determine the association of statin therapy as well as EAT and PCAT characteristics with NRS. Odds ratios (OR) and 95% confidence intervals (CI) are depicted per 1 standard deviation increase for all fat measures.
Results: A total of 321 patients (mean age: 55.5 ± 14.7 years, 62.6% male) were analyzed. Of those, 87 patients (27.1%) had a coronary plaque with NRS in at least one coronary segment. 192 patients (60%) received statin therapy. Statin therapy was more frequently present in patients with NRS (OR 4.89, 95% CI: 2.89-8.32, p=<0.001). EAT volume was strongly associated with the presence of NRS, with a higher OR in patients without statin therapy (OR: 3.31, 95% CI: 2.53–4.34, p<0.0001) compared to those receiving statins (OR: 1.50, 95% CI: 1.19–1.90, p<0.0001). EAT attenuation displayed an inverse association with NRS, especially marked in patients without statin therapy (OR: 0.69, 95% CI: 0.56-0.86, p<0.0001 vs. OR 0.51 95% CI: 0.42-0.62, p<0.0001 for patients with vs. without statin therapy). For PCAT, volume was significantly linked to NRS, with a stronger association in those not receiving statins (OR: 5.32, 95% CI: 2.87–9.87, p<0.0001) than in statin users (OR: 2.65, 95% CI: 1.61–4.36, p<0.0001).
Conclusion: In this retrospective cohort of patients undergoing coronary CT angiography, statin therapy attenuated the association of EAT volume and attenuation as well as PCAT volume with NRS. Our results suggest that the effect of lipid-lowering therapy on NRS may in parts be explained by an interplay with epicardial fat depots.