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Peri-coronary inflammation is associated with findings on coronary computed tomography angiography and fractional
Masahiro Hoshino1, Seokhun Yang2, Tomoyo Sugiyama1
1Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
Insights
The fat attenuation index (FAI) on coronary CT angiography correlates with plaque characteristics and cardiac mass in patients with intermediate coronary artery stenosis. This comprehensive assessment aids in risk stratification for cardiac events.
Area of Science:
- Cardiovascular imaging
- Radiology
- Biomedical engineering
Background:
- Peri-coronary adipose tissue attenuation, quantified by the fat attenuation index (FAI) on coronary CT angiography (CCTA), indicates inflammation and predicts cardiac mortality.
- Understanding the relationship between FAI and detailed plaque characteristics is crucial for risk stratification.
Purpose of the Study:
- To investigate the association between FAI and both whole vessel and lesion-specific plaque quantification on CCTA.
- To evaluate FAI in stable patients with intermediate epicardial stenosis, using fractional flow reserve (FFR) as a reference standard.
Main Methods:
- 187 left anterior descending arteries (LAD) with intermediate stenosis underwent FFR measurement and CCTA.
- FAI was calculated from mean CT attenuation values of the LAD.
- Multivariate analysis explored determinants of FAI and FFR, and assessed the impact of FAI and plaque characteristics on ischemia discrimination.
Main Results:
- Mean FAI was -73.0, with a median FFR of 0.77.
- Male sex, positive remodeling, lower minimum lumen area, higher cardiac mass, and lower FFR independently predicted higher FAI.
- FAI and CCTA-derived plaque quantification were independently associated with FFR values.
- FAI improved risk reclassification for lesions with FFR <0.75.
Conclusions:
- FAI is associated with FFR, detailed plaque quantification, and cardiac mass in intermediate LAD lesions.
- Comprehensive CCTA assessment, including FAI, offers potential for improved cardiovascular risk stratification.
Purpose:
Peri-coronary adipose tissue attenuation expressed by fat attenuation index (FAI) on coronary CT angiography (CCTA) reflects peri-coronary inflammation and is associated with cardiac mortality. We aimed to investigate the association between FAI and whole vessel and lesion plaque quantification on CCTA in stable patients with intermediate epicardial stenosis evaluated by fractional flow reserve (FFR).
Methods:
A total of 187 left anterior descending arteries (LAD) with intermediate stenosis who underwent FFR measurement and CCTA were studied. FAI was assessed by the crude analysis of the mean CT attenuation value of LAD on CCTA. Determinants of FAI and FFR were explored. Furthermore, the impact of combined baseline data, CCTA-derived lesion plaque assessment, whole vessel quantification, cardiac mass and FAI on discrimination efficacy for ischemia was evaluated as FFR used for a reference standard.
Results:
The mean FAI and the median FFR values were -73.0 and 0.77, respectively. Multivariate analysis revealed that male, CCTA-derived positive remodeling, lower minimum lumen area, higher target vessel total cardiac mass, and lower FFR were independent predictors of FAI. CCTA-derived two-dimensional and three-dimensional analysis and FAI were independently and significantly associated with FFR values. Net reclassification index and integrated discrimination improvement index were both significantly improved when FAI was added to the baseline model for lesions with FFR <0.75, but not for FFR≤0.80.
Conclusions:
FAI was associated with FFR, CCTA-derived two-dimensional and three-dimensional lumen and plaque quantification and cardiac mass in patients with intermediate lesions in LAD, indicating that comprehensive CTA assessment may provide risk-stratification.
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