Imaging residual inflammatory cardiovascular risk

Area of Science:

• Cardiovascular Medicine
• Radiology
• Biomarkers

Background:

• Residual cardiovascular risk, particularly inflammatory risk, remains a challenge in primary and secondary prevention.
• Current methods for detecting coronary inflammation lack specificity or accessibility, hindering precision medicine approaches.
• Coronary computed tomography angiography (CCTA) identifies high-risk plaque but offers only indirect evidence of inflammation.

Purpose of the Study:

• To introduce and evaluate the perivascular fat attenuation index (FAI) as a novel method for assessing coronary inflammation.
• To discuss the potential of FAI in enhancing cardiovascular risk discrimination and guiding therapeutic interventions.
• To provide a practical guide for utilizing non-invasive modalities for coronary inflammation detection in clinical practice.

Main Methods:

• Analysis of perivascular adipose tissue composition changes using routine CCTA data.
• Assessment of three-dimensional gradients of perivascular attenuation.
• Adjustment for technical, anatomical, and biological factors to quantify FAI.

Main Results:

• Perivascular FAI captures inflammatory signals from the coronary artery by analyzing perivascular adipose tissue.
• FAI enhances cardiovascular risk discrimination by directly detecting vascular inflammation.
• This method supports the cost-effective deployment of novel anti-inflammatory therapeutic agents.

Conclusions:

• Perivascular FAI represents a promising non-invasive tool for detecting coronary inflammation.
• FAI can improve the identification of patients who would benefit from targeted anti-inflammatory therapies.
• Integrating FAI into clinical practice can facilitate precision medicine for cardiovascular disease management.