Research On The Relationship Between The Pericoronary Adipose Tissue Measured By Artificial Intelligence And Type 2 Diabetes Mellitus

Objective:The purpose of this study was to determine the fat attenuation index(FAI)and volume of peripheral adipose tissue(PCAT)in type 2 diabetes mellitus(T2DM)and non diabetes mellitus(DM)patients by artificial intelligence,to explore the difference of PCAT volume and FAI between T2DM patients and non DM patients,objective to explore the characteristics of PCAT in patients with T2DM.And to investigate the changes of PCAT in patients with T2DM complicated with coronary atherosclerosis,and to explore the correlation between the nature of coronary atherosclerotic plaque and the degree of stenosis and PCAT,so as to provide data support for the diagnosis and treatment of T2DM patients with coronary atherosclerotic plaque.Materials and methods:From June 2019 to September 2020,253 T2DM patients and 150 non DM patients who underwent coronary computed tomography angiography(CCTA)were enrolled in this study.The clinical data of all subjects were recorded.CT image analysis software was used to delineate the 4 mm tubular area around the proximal segment of left anterior descending artery(LAD),left circumflex artery(LCX)and right coronary artery(RCA),and the volume of FAI and PCAT were calculated automatically.The characteristics of three coronary plaques(non-calcified plaque,calcified plaque,mixed plaque),and the degree of stenosis(grade 0:no stenosis and plaque,grade 1:0%-24%,grade 2:25%-49%,grade 3:50%-69%,grade 4:70%-99%,grade 5:100%;no stenosis:grade 0,mild stenosis:grade 1,grade 2,moderate stenosis:grade 3,severe stenosis:grade 4,grade 5)were recorded in T2DM patients.The distribution differences of PCAT in different gender and age were analyzed,and the differences of FAI and volume of PCAT between T2DM patients and non DM patients were compared.Then,the risk factors of coronary atherosclerotic plaque were analyzed by multivariate logistic single factor and multi factor regression analysis.Then Kruskal Wallis H test and Bonferroni correction method were used to analyze the differences of FAI and PCAT volume in T2DM patients with different plaque nature and stenosis degree.Results:(1)There was no significant difference in gender,age,BMI,smoking,drinking,hypertension,hyperlipidemia and hyperuricemia between the two groups(P>0.05).(2)PCAT FAI of three coronary arteries in T2DM patients was higher than that in non DM patients(LAD:P=0.001,LCX:P=0.006,RCA:P<0.001).There was no significant difference in PCAT volume of three coronary arteries between T2DM patients and non DM patients(P>0.05).(3)Gender(P=0.021),age(P=0.012),hypertension(P=0.015),years of type 2 diabetes(P=0.005),RCA-FAI(P=0.013)were associated with coronary atherosclerosis.Gender,age,hypertension,years of type 2 diabetes,RCA-FAI were risk factors of coronary atherosclerosis in T2DM patients.After adjusting for other risk factors,RCA-FAI(P<0.001;OR:1.155;95%CI:1.089-1.226),age(P=0.044;OR:1.052;95%CI:1.001-1.105),years of type 2 diabetes(P=0.012:OR:1.114;95%CI:1.024-1.213)were important independent risk factors of coronary atherosclerosis.RCA-FAI has a negative effect on the occurrence of coronary atherosclerotic plaque in T2DM patients,Age and type 2 diabetes years have a positive effect on the occurrence of coronary atherosclerotic plaque in T2DM patients.The ROC curve of RCA FAI value judging coronary atherosclerosis showed that AUC value was 0.604,and the threshold value was-79.5HU.RCA FAI combined with age and years of T2DM can improve the sensitivity(90.2%)and accuracy(76.3%).(4)Among T2DM patients with coronary atherosclerotic plaque,LAD-FAI,LCX-FAI,LAD-PCAT volume and LCX-PCAT volume had no correlation with plaque nature(P>0.05),but LCX-FAI and LAD-PACT volume had no correlation with stenosis degree(P>0.05).There were statistical differences in RCA-FAI between non calcifiedand and non calcified plaques(P=0.024),mixed plaques(P=0.021),There were significant differences in RCA-FAI between calcified plaque and non calcified plaque(P=0.044),mixed plaque(P=0.046).There were significant differences in RCA-PCAT volume between non plaque and mixed plaque(P=0.032).There were significant differences in LAD-FAI between non stenosis and moderate stenosis(P=0.033).There were significant differences in LCX-PCAT volume between severe stenosis and no stenosis(P=0.022)and mild stenosis(P=0.029).There were significant differences in RCA-FAI between severe stenosis and no stenosis(P=0.022),mild stenosis(P=0.012).There were significant differences in RCA-PCAT volume between severe stenosis and no stenosis(P=0.004),mild stenosis(P=0.005).Conclusions:(1)FAI increased in T2DM patients.(2)This study shows that RCA-FAI based on AI measurement is helpful to predict the possibility of coronary atherosclerotic plaque in T2DM patients.RCA-FAI(>-79.5HU),age(>68.5 years)and T2DM years(>0.5 years)are independent risk factors for coronary atherosclerotic plaque in T2DM patients.The combination of the three indicators can improve the predictive value.(3)In T2DM patients with coronary atherosclerotic plaques,PCAT may be related to the progression of plaques.