Investigating the peri-saphenous vein graft fat attenuation index on computed tomography angiography: relationship with progression of venous coronary artery bypass graft disease and temporal trends.

To clarify the fat attenuation index (FAI) change trend of peri-saphenous vein graft (SVG) and determine the association between FAI and graft disease progression based on CCTA images. Patients with venous coronary artery bypass grafts (CABGs) were consecutively enrolled in this retrospective study. In study 1, 72 patients who had undergone 1, 3, and 5 years of CCTA examinations without graft occlusion were recruited, and generalized estimation equation was used to analyze the peri-SVG FAI change trend over time. In study 2, 42 patients with graft disease progression and 84 patients as controls were propensity score-matched. Generalized linear mixed model and continuous net reclassification improvement (NRI) were used for assessing the associations with graft disease progression. Multivariable Cox regression analysis was used for assessing risk factors predicting cardiac events. In study 1, both the FAI of proximal right coronary artery and SVG decreased over time. In study 2, the 1-year CTA-derived FAI of grafts and graft anastomosis were independent indicators of graft disease progression at the 3-year CCTA follow-up (graft: odds ratio [OR] = 1.106; 95% confidence interval [CI] = 1.030-1.188, P = 0.006; graft anastomosis: OR = 1.170, 95% CI = 1.091-1.254, P < 0.001). Inclusion of the graft anastomosis FAI significantly improved reclassification compared with graft FAI (continuous NRI = 0.638, 95% CI: 0.345-0.931, P < 0.001). Moreover, The graft anastomosis FAI was found to be a risk factor for cardiac events after CABG and no statistically significant difference was found in the graft FAI (graft anastomosis: HR = 1.158, 95% CI = 1.034-1.297, P = 0.011; graft: HR = 1.116, 95% CI = 0.995-1.251, P = 0.061). A synchronism was found in the FAI change trend between native coronary artery and venous graft, which both decreased over time. The CCTA-derived FAI of venous grafts showed the potential of demonstrating SVG disease progression and graft anastomosis served as the optimal measured location.

Han L ，Like L ，Wang M ，Zhou M ，Xu Z ，Yan F ，Zhao Q ，Yang W ... -  《BMC Cardiovascular Disorders》

Predictive value of the perivascular fat attenuation index for MACE in young people suspected of CAD.

The perivascular fat attenuation index (FAI) evaluated by coronary computed tomographic angiography (CCTA) has been reported to have strong prognostic value, but few studies have focused on young people. This study aimed to assess the predictive value of the perivascular FAI in young people suspected of having coronary atherosclerotic disease (CAD). A retrospective analysis was performed on adults aged ≤ 45 years who underwent CCTA due to suspected CAD between 2015 and 2016 and who were followed up for at least 5 years following their visit (n = 503). The perivascular FAI at the proximal segment of the right coronary artery (RCA) was measured and grouped into high FAI and low FAI according to the optimal cut-off value, and the association between a high FAI and major adverse cardiac events (MACE) was evaluated by Cox hazard regression. K‒M survival analysis was conducted to assess the prognostic value of the perivascular FAI and improvement over traditional risk factor prediction methods. The event-free survival of patients in the high FAI group (FAI≥-75.2 HU) was significantly lower than that of patients in the low FAI group (FAI<-75.2 HU) at a median follow-up of 72.7 months (93.9% vs. 99.7%, P < 0.001). A high FAI (HR = 19.257, 95% CI: 2.504-148.107, P = 0.004) showed a significant correlation with an increased risk of MACE in young people. The prediction accuracy of MACE can be improved by including a high FAI on the basis of the traditional risk factor model, and the area under the curve (AUC) increased from 0.728 to 0.845 (P < 0.001). Moreover, the new model revealed significant improvements in integrated discrimination (IDI = 0.033, 95% CI: 0.009-0.103, P = 0.014) and the net reclassification index (NRI = 0.597, 95% CI: 0.000-0.699, P = 0.024). The high perivascular FAI at the proximal segment of the RCA is significantly associated with an increased risk of long-term MACE and may be a potential tool for cardiovascular risk stratification in young people suspected of CAD.

Yu Y ，Shan D ，Wang X ，Liu Z ，Dou G ，Yang J ，Liu Y ，Chen Y ... -  《BMC Cardiovascular Disorders》

The predictive value of lesion-specific pericoronary fat attenuation index for major adverse cardiovascular events in patients with type 2 diabetes.

The purpose of this study was to explore the prognostic significance of the lesion-specific pericoronary fat attenuation index (FAI) in forecasting major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM). This study conducted a retrospective analysis of 304 patients diagnosed with T2DM who underwent coronary computed tomography angiography (CCTA) in our hospital from December 2011 to October 2021. All participants were followed for a period exceeding three years. Detailed clinical data and CCTA imaging features were carefully recorded, encompassing lesion-specific pericoronary FAI, FAI of the three prime coronary arteries, features of high-risk plaques, and the coronary artery calcium score (CACS). The MACE included in the study comprised cardiac death, acute coronary syndrome (which encompasses unstable angina pectoris and myocardial infarction), late-phase coronary revascularization procedures, and hospital admissions prompted by heart failure. Within the three-year follow-up, 76 patients with T2DM suffered from MACE. The lesion-specific pericoronary FAI in patients who experienced MACE was notably higher compared to those without MACE (-84.87 ± 11.36 Hounsfield Units (HU) vs. -88.65 ± 11.89 HU, p = 0.016). Multivariate Cox regression analysis revealed that CACS ≥ 100 (hazard ratio [HR] = 4.071, 95% confidence interval [CI] 2.157-7.683, p < 0.001) and lesion-specific pericoronary FAI higher than - 83.5 HU (HR = 2.400, 95% CI 1.399-4.120, p = 0.001) were independently associated with heightened risk of MACE in patients with T2DM over a three-year period. Kaplan-Meier analysis showed that patients with higher lesion-specific pericoronary FAI were more likely to develop MACE (p = 0.0023). Additionally, lesions characterized by higher lesion-specific pericoronary FAI values were found to have a greater proportion of high-risk plaques (p = 0.015). Subgroup analysis indicated that lesion-specific pericoronary FAI higher than - 83.5 HU (HR = 2.017, 95% CI 1.143-3.559, p = 0.015) was independently correlated with MACE in patients with T2DM who have moderate to severe coronary calcification. Moreover, the combination of CACS ≥ 100 and lesion-specific pericoronary FAI>-83.5 HU significantly enhanced the predictive value of MACE in patients with T2DM within 3 years. The elevated lesion-specific pericoronary FAI emerged as an independent prognostic factor for MACE in patients with T2DM, inclusive of those with moderate to severe coronary artery calcification. Incorporating lesion-specific pericoronary FAI with the CACS provided incremental predictive power for MACE in patients with T2DM.

Liu M ，Zhen Y ，Shang J ，Dang Y ，Zhang Q ，Ni W ，Qiao Y ，Hou Y ... -  《Cardiovascular Diabetology》

Coronary Computed Tomography Angiography-Derived Modified Duke Index Is Associated with Peri-Coronary Fat Attenuation Index and Predicts Severity of Coronary Inflammation.

Halațiu VB ，Benedek I ，Rodean IP ，Cojocariu LO ，Mihăilă T ，Blîndu E ，Roșca A ，Mátyás BB ，Gerculy R ，Buicu F ，Benedek T ... -  《-》

The Role of Advanced Glycation End Products in Saphenous Vein Graft Failure.

We aimed to investigate the relationship between advanced glycation end product (AGE) levels in patients with saphenous vein graft (SVG) failure and in patients without SVG failure. In our study, 55 patients with a history of previous coronary artery bypass grafting (CABG) surgery, who subsequently underwent coronary angiography for any reason and were found to have either SVG occlusion or significant lesions, were included as study patients. Additionally, 55 patients who have had CABG surgery without SVG failure for at least 1 year served as the control group. AGE values of the patients were measured using the skin autofluorescence method. In our study results, we observed a significant difference in AGE levels between the two groups of patients with similar demographic characteristics (SVG failure groups AGE 3.2 [2.8-3.6] vs. control groups AGE 2.4 [2.1-2.7] p < 0.001). In the receiver operating characteristic curve analysis, we determined the ability of AGE levels to detect SVG failure with an area under the curve of 0.869. We found that in patients with AGE >3, it could detect SVG failure with a sensitivity of 70.9% and a specificity of 87.3%. Our results demonstrate that AGE levels can predict SVG failure risk inexpensively, easily, and quickly. We aimed to investigate the relationship between advanced glycation end product (AGE) levels in patients with saphenous vein graft (SVG) failure and in patients without SVG failure. In our study, 55 patients with a history of previous coronary artery bypass grafting (CABG) surgery, who subsequently underwent coronary angiography for any reason and were found to have either SVG occlusion or significant lesions, were included as study patients. Additionally, 55 patients who have had CABG surgery without SVG failure for at least 1 year served as the control group. AGE values of the patients were measured using the skin autofluorescence method. In our study results, we observed a significant difference in AGE levels between the two groups of patients with similar demographic characteristics (SVG failure groups AGE 3.2 [2.8-3.6] vs. control groups AGE 2.4 [2.1-2.7] p < 0.001). In the receiver operating characteristic curve analysis, we determined the ability of AGE levels to detect SVG failure with an area under the curve of 0.869. We found that in patients with AGE >3, it could detect SVG failure with a sensitivity of 70.9% and a specificity of 87.3%. Our results demonstrate that AGE levels can predict SVG failure risk inexpensively, easily, and quickly.

Akgümüş A ，Boyraz B ，Balun A 《-》