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Prognostic Value of Pericoronary Fat Attenuation Index on Computed Tomography for Hospitalization for Heart Failure
Mitsutaka Nakashima1, Toru Miyoshi1, Takahiro Nishihara1
1Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Insights
Pericoronary fat attenuation index (FAI) predicts heart failure with preserved ejection fraction (HFpEF) hospitalizations. Inflammation in the left anterior descending and left circumflex arteries identified high-risk patients.
Area of Science:
- Cardiology
- Radiology
- Biomedical Imaging
Background:
- Pericoronary fat attenuation index (FAI) on computed tomography reflects coronary artery inflammation.
- Inflammation is implicated in the pathophysiology of heart failure with preserved ejection fraction (HFpEF).
Purpose of the Study:
- To determine if pericoronary FAI predicts hospitalization for HFpEF.
- To assess the association between pericoronary inflammation and HFpEF risk.
Main Methods:
- Retrospective analysis of 1,196 patients undergoing coronary computed tomography angiography (CCTA) and echocardiography.
- FAI assessment of major epicardial coronary arteries.
- Primary outcome: hospitalization for HFpEF, analyzed using Cox regression and ROC curves.
Main Results:
- During 4.3 years, 29 HFpEF hospitalizations occurred.
- Higher LAD-FAI (≥-63.4 HU) and LCx-FAI (≥-61.6 HU) significantly predicted HF hospitalization (HR: 4.8 and 4.5).
- LAD-FAI improved HFpEF prediction model performance (C-statistic from 0.646 to 0.750).
Conclusions:
- Pericoronary FAI, particularly in the LAD and LCx arteries, is a significant predictor of HFpEF hospitalization.
- FAI quantifies pericoronary inflammation, aiding in identifying patients at high risk for HFpEF development.
Background:
Pericoronary fat attenuation index (FAI) assessed on computed tomography is associated with the inflammation of the pericoronary artery.
Objectives:
This study aimed to investigate whether pericoronary FAI predicts hospitalization for heart failure with preserved ejection fraction (HFpEF).
Methods:
This retrospective single-center study included 1,196 consecutive patients who underwent clinically indicated coronary computed tomography angiography (CCTA) and transthoracic echocardiography. We assessed the FAI of proximal 40-mm segments for each major epicardial coronary vessel. The primary outcome was the incidence of hospitalization for HFpEF. Patients were divided into groups based on the optimal cutoff value for predicting hospitalization for HFpEF by receiver operating characteristic curve analysis.
Results:
During a median follow-up of 4.3 years, 29 hospitalizations for HFpEF occurred. Multivariable Cox regression analysis revealed that a left anterior descending artery (LAD)-FAI ≥-63.4 HU and a left circumflex artery-FAI ≥-61.6 HU were significantly associated with hospitalization for HF after adjustment for age and sex (HR: 4.8; 95% CI: 2.1-10.8 and HR: 4.5; 95% CI: 2.1-9.4, respectively). The addition of LAD-FAI >-63.4 HU to a model incorporating other risk factors, including hypertension, estimated glomerular filtration rate <60 mL/min/1.73 m2, and significant stenosis on CCTA, increased the C-statistic for predicting hospitalization for HFpEF from 0.646 to 0.750 (P = 0.010).
Conclusions:
LAD- and left circumflex artery-FAI can predict hospitalization for HFpEF in patients undergoing clinically indicated CCTA. Pericoronary inflammation may be useful for identifying patients at high risk of developing HFpEF.
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