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Integrated CT-derived fractional flow reserve and perivascular fat attenuation index: a multimodal approach to
Wentao Zhao1, Ling Huang1, Mingyuan Zhu1
1Department of Radiology, The Second Qilu Hospital of Shandong University, Jinan, China.
Insights
A new CT-FAI-FFR score effectively predicts in-stent restenosis (ISR) after stenting by combining inflammation and blood flow data. This multimodal approach improves risk stratification for patients undergoing percutaneous coronary intervention.
Area of Science:
- Cardiology
- Medical Imaging
- Biomarkers
Background:
- In-stent restenosis (ISR) after percutaneous coronary intervention (PCI) with stenting negatively impacts patient outcomes.
- Pericoronary fat attenuation index (FAI) and coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) are emerging non-invasive biomarkers for ISR.
- These biomarkers may play a role in ISR through inflammation and hemodynamic mechanisms.
Purpose of the Study:
- To develop and validate an integrated multimodal predictive model for drug-eluting stent (DES)-associated ISR.
- The model combines CT-FFR and pericoronary FAI for enhanced ISR assessment.
Main Methods:
- Retrospective cohort study of 144 patients (225 lesions) with coronary CT angiography (CCTA) and subsequent angiographic follow-up.
- CT-FFR reconstructed using deep learning; pericoronary FAI quantified at the stented segment.
- A hybrid-effects logistic regression model created the CT-FAI-FFR score; predictive efficacy assessed via ROC analysis.
Main Results:
- ISR occurred in 24.4% of lesions during a median 25.5-month follow-up.
- The integrated CT-FAI-FFR model achieved an AUC of 0.793 for ISR prediction.
- This performance significantly outperformed baseline assessment (AUC 0.656, p=0.009).
Conclusions:
- The CT-FAI-FFR score improves ISR risk stratification by integrating hemodynamic and inflammatory data.
- This suggests a pathophysiological link between perivascular inflammation and hemodynamic impairment in ISR development.
Background:
A significant proportion of patients develop in-stent restenosis (ISR) following percutaneous coronary intervention (PCI) with stent implantation, adversely impacting long-term outcomes. Pericoronary fat attenuation index (FAI) and coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) represent emerging non-invasive imaging biomarkers potentially contributing to ISR pathogenesis through inflammatory and hemodynamic mechanisms.
Objective:
To construct and evaluate an integrated multimodal predictive model integrating non-invasive computed tomography angiography-derived fractional flow reserve (CT-FFR) and pericoronary fat attenuation index (FAI) for assessing drug-eluting stent (DES)-associated ISR.
Methods:
This retrospective cohort study enrolled 144 patients (225 coronary lesions) undergoing coronary CT angiography (CCTA) between 2020 and 2024, followed by PCI within one month and subsequent angiographic follow-up (either invasive coronary angiography or CCTA). Computed tomography angiography-derived fractional flow reserve (CT-FFR) values for target lesions were reconstructed using deep learning algorithms. Pericoronary FAI was quantified at the stented coronary segment. The primary endpoint was angiographically confirmed in-stent restenosis (ISR, defined as luminal stenosis ≥50%) during follow-up. A hybrid-effects logistic regression model generated the integrated CT-FAI-FFR score. Predictive efficacy was evaluated using receiver operating characteristic (ROC) curve analysis and decision curve analysis.
Results:
During a median follow-up duration of 25.5 months, ISR occurred in 55 lesions (24.4%). The study cohort was 67.0% male. the multimodal CT-FAI-FFR model achieved an area under the ROC curve (AUC) of 0.793 for predicting ISR. This predictive performance significantly surpassed that of the baseline alone (AUC 0.656, p = 0.009).
Conclusion:
The CT-FAI-FFR score optimizes ISR risk stratification by integrating complementary information reflecting hemodynamic impairment and local vascular inflammation. This finding suggests a potential pathophysiological interplay between perivascular inflammation and hemodynamic impairment in ISR development.
