| Part Ⅰ:Coronary CTA evaluation of coronary artery plaque characteristics among people infected with HIVBackground and ObjectiveThe application of antiretroviral therapy(ART)has significantly reduced the mortality of human immunodeficiency virus(HIV)infection related diseases.Cardiovascular disease has become a prominent factor threatening the death of HIV infected people.The formation of coronary atherosclerotic plaque is the pathological basis of coronary heart disease.Coronary CT angiography(CCTA)can not only observe the nature of plaque,but also evaluate the degree of lumen stenosis.The purpose of this study was to qualitatively and quantitatively detect the characteristics of coronary plaque through CCTA,and to evaluate the profile of coronary artery disease in HIV infected people who have received art for a long time.Materials and Methods135 HIV infected persons(HIV group)suspected of coronary heart disease who underwent CCTA in our hospital from March 2017 to December 2021 were collected;135 non-HIV infected patients were matched according to the traditional cardiovascular risk factors 1:1(non-HIV group).The relevant test results of all enrolled patients were collected.All coronary arteries with diameter>2mm were analyzed to evaluate the existence of coronary plaque,the degree of lumen stenosis and the characteristics of high-risk plaque(HRP).The degree of coronary artery stenosis>50%is obstructive stenosis.CCTA identifies the high-risk morphological characteristics of plaque,including low attenuation plaque(LAP),positive remodeling(PR),punctate calcium plaque(SC)and napkin ring sign(NRS),The plaque with the above two or more characteristics is HRP;The plaque length,total plaque volume,calcified plaque volume,lipid plaque volume,fibrous plaque volume,remodeling index(RI)and minimum lumen area(MLA)were measured semi automatically by Siemens post-processing software.The similarities and differences of the above characteristics of coronary plaque between HIV group and non-HIV group were compared and analyzed.ResultsThere were 83 and 79 patients with plaque in HIV group and non-HIV group respectively.The number of coronary artery segments with any plaque was 217 and 159 respectively.The incidence of coronary plaque in HIV group was higher than that in non-HIV group(all P<0.05);There was no significant difference in the incidence of coronary obstructive stenosis(P>0.05).The number of HRP total coronary segments in HIV group was higher than that in non-HIV group(81 vs 56),the difference was statistically significant(P=0.039),and the incidence of SC+lap+PR was higher than that in non-HIV group(P=0.028).The anatomical quantitative parameters of plaque characteristics in the two groups showed that the plaque length,total plaque volume,lipid plaque volume and fibrous plaque volume in the HIV group were higher than those in the non-HIV group(all P<0.05).There was no significant difference in the three parameters of calcified plaque volume,RI and MLA between the two groups(all P>0.05).ConclusionCompared with the non-HIV control group,the incidence of any plaque and HRP in HIV infected patients increased;Further,based on the quantitative parameter analysis of CCTA plaque,the plaque length,total plaque volume,especially the non calcified plaque volume of HIV infected people are significantly higher than those of non-HIV infected people,which is helpful to the individualized cardiovascular risk assessment of HIV infected people and guide clinical targeted treatment as soon as possible in secondary prevention.Part Ⅱ:People living with HIV epicardial adipose tissue parameters and the study on the relationship between the high-risk plaqueBackground and ObjectiveVascular inflammation is the driving factor of atherosclerotic plaque formation.Epicardial adipose tissue(EAT)promotes the formation of atherosclerosis through paracrine and reversely induces the change of fat phenotype,which shows the change of local fat volume and density,making imaging detection possible.Fat attenuation index(FAI)is a new three-dimensional imaging marker reflecting the change of CT value of Pericoronal fat.The purpose of this study is to explore the relationship between epicardial adipose tissue parameters and HRP in HIV infected people,and further analyze the risk factors affecting HRP,in order to improve the ability to evaluate the individualized cardiovascular risk of HIV infected people.Materials and Methods135 HIV infected patients suspected of coronary heart disease who underwent CCTA in our hospital from March 2017 to December 2021 were collected.According to the existence of high-risk plaque in coronary artery,they were divided into 42 cases in HRP group and 93 cases in non-HRP group.All adipose tissue between visceral pericardium and myocardial outer wall was taken as eat volume,and its average CT value was taken as eat density.The average attenuation value of adipose tissue in the range of left anterior descending artery(LAD),proximal left circumflex artery(LCX)40mm and proximal right coronary artery(RCA)10～50mm in length and width as the average diameter of corresponding blood vessels was measured as the Pericoronal FAI.The eat volume,eat density and perivascular Fai were measured by Siemens post-processing workstation.ResultsThe EAT volume,EAT density,FAI around RCA and LAD in HRP group were significantly higher than those in non-HRP group(all P<0.05),but there was no significant difference in FAI around LCX(P>0.05).Due to less branches of RCA and abundant surrounding adipose tissue,FAI around RCA was selected to replace FAI of the whole coronary tree in this study.Multivariate logistic regression showed that age[OR(95%CI):0.924(0.861～0.991),P=0.028],triglyceride[OR(95%CI):0.641(0.409～0.921),P=0.018],EAT density[OR(95%CI):0.984(0.975～0.994),P=0.002],EAT volume[OR(95%CI):0.884(0.741～0.911),P=0.001]and FAI around RCA[OR(95%CI):0.920(0.859～0.987),P=0.019]were independently associated with coronary HRP in HIV infected patients.Taking-85.81 HU as the cut-off value of FAI around RCA,the sensitivity,specificity and AUC of predicting HRP were 81.0%,60.2%,0.765.Taking-84.00HU as the cut-off value of EAT density,the sensitivity,specificity and AUC of predicting HRP were 78.0%,66.3%and 0.739 respectively.Taking 150.21cm3 as the cut-off value of EAT volume,the sensitivity of predicting high-risk plaque was 58.5%,the specificity was 65.2%,and the AUC was 0.631.There was no significant difference in AUC among the three(P>0.05).ConclusionIn HIV infected patients,the EAT volume,EAT density,FAI around RCA and fad around lad in HRP group were significantly higher than those in non-HRP group;Age,serum triglyceride level,EAT volume,EAT density and FAI around RCA may be independent influencing factors of HRP in HIV infected coronary arteries;Epicardial adipose tissue derived from CCTA can provide early coronary artery inflammation and plaque metabolism,which may be a new marker of HRP. 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