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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Relationship Between Pericoronary Fat Attenuation Index on Baseline CT and Target Vessel Revascularization in
Chentao Zhu1, Ke Shi2, Na Li2
1Department of Radiology, Huzhou Central Hospital, Huzhou, Zhejiang Province, People's Republic of China.
Insights
The pericoronary fat attenuation index (FAI) from coronary computed tomography angiography (CCTA) can predict target vessel revascularization (TVR) in patients after procedures. A specific lesion-specific FAI measurement showed significant association with TVR risk.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Interventional Cardiology
Background:
- Target vessel revascularization (TVR) is a common outcome in patients undergoing coronary interventions.
- Accurate risk stratification for TVR is crucial for optimizing patient management.
- Coronary computed tomography angiography (CCTA) offers detailed anatomical information, including pericoronary adipose tissue characteristics.
Purpose of the Study:
- To evaluate the association between pericoronary fat attenuation index (FAI) derived from CCTA and the need for TVR in symptomatic patients post-procedure.
- To determine if lesion-specific FAI can serve as a predictor of TVR.
Main Methods:
- Retrospective analysis of 154 patients with 191 coronary lesions undergoing CCTA before stenting.
- Measurement of proximal and lesion-specific pericoronary FAI using semi-automated software on pre-procedure CCTA.
- Multivariate logistic regression to identify predictors of TVR, with data split into training and testing sets.
Main Results:
- Patients requiring TVR had higher pericoronary FAI values compared to those without TVR.
- Lesion-specific pericoronary FAI (1 cm² × 2 mm) demonstrated strong diagnostic performance (AUC 0.794-0.814) for TVR prediction.
- Lesion-specific FAI was an independent predictor of TVR (OR 1.2, P=0.036) with an optimal cutoff of -70.49 HU.
Conclusions:
- CCTA-derived pericoronary FAI is significantly associated with TVR in post-procedure patients.
- The 1 cm² × 2 mm lesion-specific pericoronary FAI is an effective tool for stratifying TVR risk.
- This imaging biomarker can aid in clinical decision-making for patients requiring coronary interventions.
Objective:
To investigate the association of the pericoronary fat attenuation index (FAI) derived from coronary computed tomography angiography (CCTA) with target vessel revascularization (TVR) in symptomatic postprocedure patients.
Methods:
A retrospective analysis was conducted, including 154 patients with 191 lesions scheduled for stenting who underwent invasive coronary angiography (ICA) after preinterventional CCTA. The proximal pericoronary FAI of the 3 major coronary arteries and lesion-specific pericoronary FAI were measured on preprocedure CCTA using semi-automated software. Lesions were randomly allocated to a training set (n=133) and a test set (n=58). Multivariate logistic regression analyses were performed to identify independent variables associated with TVR in the training cohort. Analyses were performed on the patient and vessel levels.
Results:
A total of 154 patients (age 60.9±9.5 y, 68.8% male) with 191 lesions scheduled for stenting were included. On the basis of patient-level analysis, patients with TVR showed higher pericoronary FAI compared with patients without TVR. In vessel-level analysis, the regression model incorporating 1 cm 2 mm lesion-specific pericoronary FAI demonstrated superior diagnostic performance in both cohorts (training set AUC 0.814, 95% CI: 0.721-0.907; test set AUC 0.794, 95% CI: 0.659-0.928). The optimal cutoff value of -70.49 HU for the 1 cm 2 mm lesion-specific pericoronary FAI was determined by maximizing Youden's index, achieving a sensitivity of 75.0% and specificity of 63.0% in the test set. The model exhibited excellent calibration and clinical utility as confirmed by calibration curves and decision curve analysis (DCA). Multivariate logistic regression analysis showed that 1 cm 2 mm lesion-specific pericoronary FAI (OR 1.2, 95% CI: 1.01-1.42, P =0.036) was an independent predictor of TVR.
Conclusions:
CCTA-derived pericoronary FAI is significantly associated with TVR in postprocedural patients. The 1 cm 2 mm lesion-specific pericoronary FAI, with an optimal cutoff of -70.49 HU, represents an effective tool for TVR risk stratification in this patient population.
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