Physiological significance of pericoronary inflammation in epicardial functional stenosis and global coronary flow reserve.

Both fractional flow reserve (FFR) and global coronary flow reserve (g-CFR) provide prognostic information in patients with stable coronary artery disease (CAD). Inflammation plays a vital role in impaired endothelial dysfunction and atherosclerotic progression, potentially predicting cardiovascular mortality. This study aimed to evaluate the physiological significance of pericoronary adipose tissue inflammation assessed by CT attenuation (PCATA) in epicardial functional stenosis severity and g-CFR in patients with CAD. A total of 131 CAD patients with a single de novo epicardial coronary stenosis who underwent coronary CT-angiography (CCTA), phase-contrast cine-magnetic resonance imaging (PC-CMR) and FFR measurement were studied. PCATA was assessed using the mean CT attenuation value. G-CFR was obtained by quantifying absolute coronary sinus flow (ml/min/g) by PC-CMR at rest and during maximum hyperemia. Median FFR, g-CFR, and PCATA values were 0.75, 2.59, and - 71.3, respectively. Serum creatinine, NT-proBNP, left ventricular end-diastolic volume, and PCATA were independently associated with g-CFR. PCATA showed a significant incremental predictive efficacy for impaired g-CFR (< 2.0) when added to the clinical risk model. PCATA was significantly associated with g-CFR, independent of FFR. Our results suggest the pathophysiological mechanisms linking perivascular inflammation with g-CFR in CAD patients.

Kanaji Y ，Sugiyama T ，Hoshino M ，Misawa T ，Nagamine T ，Yasui Y ，Nogami K ，Ueno H ，Hirano H ，Hada M ，Yamaguchi M ，Hamaya R ，Usui E ，Yonetsu T ，Sasano T ，Kakuta T ... -  《Scientific Reports》

Impact of pericoronary adipose tissue inflammation on left ventricular hypertrophy and regional physiological indices in stable coronary artery disease patients with preserved systolic function.

Hirano H ，Kanaji Y ，Sugiyama T ，Hoshino M ，Horie T ，Misawa T ，Nogami K ，Ueno H ，Hada M ，Yamaguchi M ，Sumino Y ，Hamaya R ，Usui E ，Murai T ，Lee T ，Yonetsu T ，Kakuta T ... -  《-》

Impact of regional functional ischemia on global coronary flow reserve in patients with stable coronary artery disease.

Global coronary flow reserve (g-CFR) provides powerful prognostic information. The relationship between g-CFR and the regional physiological indices of fractional flow reserve (FFR), coronary flow reserve (r-CFR), and the index of microcirculatory resistance remains undetermined. This study aimed to assess the relationship between regional and global physiological indices and determinants of cardiovascular magnetic resonance imaging (CMR)-derived g-CFR. A total of 151 patients with single de novo intermediate to stenotic epicardial lesions referred for diagnostic invasive coronary angiography who underwent phase-contrast cine CMR of the coronary sinus (CS) were included. g-CFR was calculated as the ratio of hyperemic and resting CS flow (CSF). Regional and global physiological parameters were compared, and determinants of g-CFR were assessed. There was a weak linear relationship between FFR and g-CFR (R2=0.04, p=0.013), while r-CFR and g-CFR, or combinations of the other regional-global indices were not significantly correlated. When patients were divided into two groups by FFR of 0.80, there were also no significant differences in global physiological indices between the groups (FFR≤0.80 vs. FFR>0.80; g-CFR: 2.73 vs. 2.61, p=0.48; hyperemic CSF: 3.32 vs. 3.52ml/min/g, p=0.84). Higher high-sensitivity cardiac troponin-I (hs-cTnI) and higher resting CS flow were independently associated with impaired g-CFR, and the combination could efficiently identify patients with g-CFR<2.0. Given weak relationship among global and regional physiological indices, these indices may provide complementary efficacy for prognostication in patients with single-vessel stable coronary artery disease. Combination of hs-cTnI and resting CS flow could estimate g-CFR without pharmacological hyperemic induction.

Hamaya R ，Fukuda T ，Sugano A ，Kanaji Y ，Hada M ，Kanno Y ，Yuki H ，Hoshino M ，Yonetsu T ，Kakuta T ... -  《-》

Pre-percutaneous Coronary Intervention Pericoronary Adipose Tissue Attenuation Evaluated by Computed Tomography Predicts Global Coronary Flow Reserve After Urgent Revascularization in Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome.

Kanaji Y ，Hirano H ，Sugiyama T ，Hoshino M ，Horie T ，Misawa T ，Nogami K ，Ueno H ，Hada M ，Yamaguchi M ，Sumino Y ，Hamaya R ，Usui E ，Yonetsu T ，Sasano T ，Kakuta T ... -  《Journal of the American Heart Association》

Peri-coronary inflammation is associated with findings on coronary computed tomography angiography and fractional flow reserve.

Peri-coronary adipose tissue attenuation expressed by fat attenuation index (FAI) on coronary CT angiography (CCTA) reflects peri-coronary inflammation and is associated with cardiac mortality. We aimed to investigate the association between FAI and whole vessel and lesion plaque quantification on CCTA in stable patients with intermediate epicardial stenosis evaluated by fractional flow reserve (FFR). A total of 187 left anterior descending arteries (LAD) with intermediate stenosis who underwent FFR measurement and CCTA were studied. FAI was assessed by the crude analysis of the mean CT attenuation value of LAD on CCTA. Determinants of FAI and FFR were explored. Furthermore, the impact of combined baseline data, CCTA-derived lesion plaque assessment, whole vessel quantification, cardiac mass and FAI on discrimination efficacy for ischemia was evaluated as FFR used for a reference standard. The mean FAI and the median FFR values were -73.0 and 0.77, respectively. Multivariate analysis revealed that male, CCTA-derived positive remodeling, lower minimum lumen area, higher target vessel total cardiac mass, and lower FFR were independent predictors of FAI. CCTA-derived two-dimensional and three-dimensional analysis and FAI were independently and significantly associated with FFR values. Net reclassification index and integrated discrimination improvement index were both significantly improved when FAI was added to the baseline model for lesions with FFR <0.75, but not for FFR≤0.80. FAI was associated with FFR, CCTA-derived two-dimensional and three-dimensional lumen and plaque quantification and cardiac mass in patients with intermediate lesions in LAD, indicating that comprehensive CTA assessment may provide risk-stratification.

Hoshino M ，Yang S ，Sugiyama T ，Zhang J ，Kanaji Y ，Yamaguchi M ，Hada M ，Sumino Y ，Horie T ，Nogami K ，Ueno H ，Misawa T ，Usui E ，Murai T ，Lee T ，Yonetsu T ，Kakuta T ... -  《-》