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Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Lesion-Specific Peri-Coronary Fat Attenuation Index Is Associated With Functional Myocardial Ischemia Defined by
Shaowei Ma1,2, Xujiao Chen1, Yue Ma1
1Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
Insights
The fat attenuation index (FAI) of lesion-specific peri-coronary adipose tissue (PCAT) independently predicts functional ischemia, improving coronary computed tomography angiography (CTA) diagnostic accuracy when combined with stenosis severity.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- The relationship between invasive fractional flow reserve (FFR) and peri-coronary adipose tissue (PCAT) fat attenuation index (FAI) is not well understood.
- PCAT characteristics may offer insights into coronary artery disease (CAD) pathophysiology.
Purpose of the Study:
- To investigate the association between lesion-specific PCAT FAI and FFR values in patients with suspected or known CAD.
- To evaluate the diagnostic performance of FAI in predicting functionally significant coronary artery stenosis.
Main Methods:
- Retrospective analysis of 227 patients undergoing coronary computed tomography angiography (CTA) and invasive coronary angiography (ICA) with FFR measurement.
- Calculation of lesion-specific FAI (FAIlesion), lesion-free FAI (FAInormal), and epicardial adipose tissue (EAT) parameters.
- Logistic regression and receiver operating characteristic (ROC) curve analysis to assess associations with FFR <0.8.
Main Results:
- FAIlesion was significantly higher in lesions with FFR <0.8 (indicating functional ischemia) compared to those without.
- Neither EAT volume/attenuation nor FAInormal differentiated between patients with or without abnormal FFR.
- Both CTA-assessed stenosis severity and FAIlesion independently predicted functional ischemia.
Conclusions:
- Lesion-specific FAI, not general EAT parameters, is independently associated with abnormal FFR.
- Combining FAIlesion with CTA-assessed stenosis severity enhances diagnostic performance for detecting functional ischemia, approaching the accuracy of ICA.
Abstract:
Background: The association between abnormal invasive fractional flow reserve (FFR) and the fat attenuation index (FAI) of lesion-specific peri-coronary adipose tissue (PCAT) is unclear. Method: Data of patients who underwent coronary computed tomography angiography (CTA) and subsequent invasive coronary angiography (ICA) and FFR measurement within 1 week were retrospectively included. Lesion-specific FAI (FAIlesion), lesion-free FAI (FAInormal), epicardial adipose tissue (EAT) volume and attenuation was collected, along with stenosis severity and plaque characteristics. Lesions with FFR <0.8 were considered functionally significant. The association between FFR and each parameter was analyzed by logistic regression or receiver operating characteristic curve. Result: A total of 227 patients from seven centers were included. EAT volume or attenuation, traditional risk factors, and FAInormal (with vs. without ischemia: -82 ± 11 HU vs. -81 ± 11 HU, p = 0.65) were not significantly different in patients with or without abnormal FFR. In contrast, lesions causing functional ischemia presented more severe stenosis, greater plaque volume, and higher FAIlesion (with vs. without ischemia: -71 ± 8 HU vs. -76 ± 9 HU, p < 0.01). Additionally, the CTA-assessed stenosis severity (OR 1.06, 95%CI 1.04-1.08, p < 0.01) and FAIlesion (OR 1.08, 95%CI 1.04-1.12, p < 0.01) were determined to be independent factors that could predict ischemia. The combination model of these two CTA parameters exhibited a diagnostic value similar to the invasive coronary angiography (ICA)-assessed stenosis severity (AUC: 0.820 vs. 0.839, p = 0.39). Conclusion: It was FAIlesion, not general EAT parameters, that was independently associated with abnormal FFR and the diagnostic performance of CTA-assessed stenosis severity for functional ischemia was significantly improved in combination with FAIlesion.
