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Updated: Jul 2, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Relationship between peri-coronary inflammation and coronary vascular function in patients with suspected coronary
Mengyu Chen1,2,3, Bing Liu1,2,3, Xu Li1,2,3
1Department of Radiology, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China.
Insights
The fat attenuation index (FAI) of peri-coronary adipose tissue is linked to reduced coronary flow reserve (CFR) in patients with suspected coronary artery disease (CAD). FAI can identify microcirculatory damage, even without obstructive epicardial artery stenosis.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Biomedical Engineering
Background:
- Coronary artery disease (CAD) diagnosis relies on assessing coronary vascular function.
- Peri-coronary adipose tissue (PCAT) characteristics may reflect underlying inflammation and vascular dysfunction.
- The fat attenuation index (FAI) is a novel CT-derived marker of PCAT properties.
Purpose of the Study:
- To investigate the association between PCAT attenuation (FAI) and coronary flow reserve (CFR) in patients with suspected CAD.
- To determine if FAI can predict impaired coronary microvascular function.
- To evaluate FAI's utility in patients with and without obstructive CAD.
Main Methods:
- 364 patients with suspected CAD underwent 13N-NH3 PET/CT and coronary computed tomography angiography (CCTA).
- Coronary flow reserve (CFR) was assessed using 13N-NH3 PET/CT.
- Fat attenuation index (FAI) and other CT-derived parameters of PCAT and coronary arteries were quantified.
Main Results:
- Reduced CFR (<2.5) was observed in 57% of patients.
- Patients with reduced CFR had higher FAI values and a greater prevalence of diffused atherosclerosis.
- On vessel-level analysis, reduced CFR was associated with obstructive CAD, diffused atherosclerosis, low-attenuation plaque, and positive remodeling.
- FAI was independently associated with CFR, even after adjusting for traditional risk factors and in patients without obstructive CAD.
Conclusions:
- Coronary perivascular inflammation, assessed by FAI, is independently associated with coronary vascular function.
- FAI is elevated in patients with reduced CFR, particularly those without obstructive coronary artery disease.
- FAI serves as a valuable imaging biomarker for detecting microcirculatory dysfunction in suspected CAD.
Background:
In this study, we aim to investigate the relationship between the attenuation of peri-coronary adipose tissue (PCAT) in patients with suspected coronary artery disease (CAD) and the assessment of coronary vascular functions using coronary flow reserve (CFR).
Methods:
We included 364 patients who underwent 13N-NH3 positron emission tomography/computed tomography and coronary computed tomography angiography (CCTA). We determined the relationship between fat attenuation index (FAI), PCAT volume, and other qualitative CT-derived anatomic parameters with CFR.
Results:
We detected a decrease in CFR (<2.5) in 206 (57%) patients. At the patient level, those with reduced CFR showed a significantly higher prevalence of diffused atherosclerosis (41% vs. 23%; P < 0.001) and higher FAI (-75.5 HU vs. -77.1 HU; P = 0.014). In patients without obstructive CAD, FAI was significantly higher in those with reduced CFR (-75.5 HU vs. -77.7 HU, P = 0.026). On the vessel level, 1,092 vessels were analyzed, and 642 (59%) exhibited reduced CFR. The vessels with reduced CFR presented a significantly higher prevalence of obstructive CAD (37% vs. 26%; P < 0.001), diffused atherosclerosis (22% vs. 11%; P < 0.001), low-attenuation plaque (6% vs. 3%; P = 0.030), and positive remodeling (7% vs. 2%; P = 0.001). FAI was higher in vessels with reduced CFR (-80.8 HU vs. -81.8 HU; P = 0.045) than in normal CFR. In the patient-level analysis, obstructive CAD, diffused atherosclerosis, and FAI were independently linked with CFR. FAI was still associated with global CFR after adjusting for traditional risk factors (age, hypertension, diabetes, hyperlipidemia, and smoking). FAI remained independently associated with reduced CFR in patients without obstructive CAD.
Conclusions:
Coronary perivascular inflammation evaluated by CCTA was independently associated with coronary vascular function. In patients without obstructive CAD, FAI was higher in the presence of reduced CFR. Altogether, FAI can help reveal microcirculatory damage in patients who do not exhibit epicardial artery stenosis.
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