Impact of pericoronary adipose tissue attenuation and coronary microvascular dysfunction on cardiac remodeling and dysfunction.

We aimed to examine the impact of coronary inflammation, coronary microvascular dysfunction (CMD), and coronary artery spasm (CAS) on cardiac remodeling and dysfunction in patients suspected of angina with non-obstructive coronary artery disease (ANOCA). This retrospective single-center study included consecutive patients who underwent coronary spasm provocation testing between July 2020 and January 2025 for suspected ANOCA without prior revascularization and coronary stenosis ≥ 75%. Those who underwent coronary angiography after September 2022 also underwent invasive coronary physiology studies to diagnose structural CMD. PCAT attenuation (PCATA), reflecting coronary inflammation, was measured from prior coronary CT angiography, while strain analyses were obtained from prior echocardiography. Regression models were established between echocardiographic parameters and each of PCATA, CMD, and CAS. 257 patients (mean age, 64.2 ± 12.2 years; male, 62.1%) were included in the analysis. Multivariable regression analyses including PCATA, CMD, and CAS demonstrated that higher PCATA was associated with higher left ventricular mass index (β = 0.25, p = 0.007), reduced left ventricular ejection fraction (β = -0.21, p = 0.01), and impaired right ventricular four-chamber strain (β = 0.21, p = 0.04). CMD was independently associated with higher left atrial volume index (β = 0.67, p = 0.002) and impaired left atrial contraction strain (β = 5.31, p = 0.009). CAS showed no correlation with these parameters. Our study demonstrated a significant association between PCATA and left ventricular remodeling and dysfunction independent of CMD. It also revealed a direct relationship between CMD and left atrial remodeling and dysfunction.