Right coronary artery pericoronary fat attenuation index as a future predictor for acute coronary events in nonobstructive coronary artery disease - a prospective single centre study.

Evaluation of pericoronary adipose tissue changes induced by inflammation by non-invasive techniques is challenging. To find the association between pericoronary adipose tissue attenuation (FAI) changes and future acute coronary events in nonobstructive coronary artery disease. Ours was a single-centre, prospective observational study on patients with atypical chest pain who underwent coronary computed tomography angiography (CCTA). In patients with CADRADS 1 to 3 nonobstructive coronary artery disease (CAD), pericoronary FAI was measured around the proximal right coronary artery (RCA) and coronary artery segment with plaque using semi-automated postprocessing software. Patients were followed up for development of acute coronary events (ACE). Kaplan-Meier curves were used to see event-free survival rates. Of 120 patients with a mean follow-up period of 67 months, 21 patients developed acute coronary events. RCA-FAI and lesion FAI of patients with ACE were significantly higher as compared to patients without events. ROC curve analysis showed RCA-FAI as the best predictor of ACE at a cut-off point of > -77.3 Hounsfield unit (HU) (with an AUC of 0.915) with high sensitivity (95.24%), specificity (83.84%), and negative predictive value (98.80%). On multivariate analysis, RCA-FAI, diabetes mellitus, and stenosis ≥50% were independent risk factors of ACE with hazard ratios of 1.335 (1.173-1.518), 4.950 (1.716-14.278), and 7.446 (2.257-24.566), respectively. RCA FAI can predict ACE in nonobstructive coronary artery disease patients. Detection of high RCA FAI of > -77.3 HU on CCTA can help to identify high-risk patients who need regular follow-up and early initiation of interventions.

Biradar B ，Valakkada J ，Ayappan A ，Kannath S ，Sasidharan B ，Alex A ... -  《-》

Predictive value of pericoronary fat attenuation index for graft occlusion after coronary artery bypass grafting.

Based on coronary computed tomography angiography (CCTA), this study aimed to evaluate the predictive value of pericoronary fat attenuation index (FAI) for graft occlusion in patients following coronary artery bypass grafting (CABG). The clinical and imaging data of 100 patients with coronary artery disease (CAD) who underwent CCTA and subsequently received successful CABG between December 2012 and March 2024 were retrospectively collected. According to the subsequent CCTA evaluation of grafts, they were categorized into occlusion group (n = 27) and patency group (n = 73). Based on CCTA images, FAI of the proximal segment of the three coronary arteries and epicardial adipose tissue (EAT) parameters were measured and compared between the two groups. The Cox regression model was employed to screen the independent predictors of graft occlusion. The predictive model was constructed, and the receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic performance of the model. Among the 100 cases, 74 were males, with a mean age was 62.42 ± 7.57 years. During the 15.50 (5.00, 36.75) months follow-up period, grafting vessel occlusion occurred in 27 patients (27.0%). The right coronary artery (RCA) in occlusion group was -73.36 ± 7.24HU, which was notably higher compared to patency group (-79.93 ± 9.75HU) (P < 0.05). Multivariable Cox regression analysis indicated that RCA FAI (HR = 5.205, 95% CI 1.938-13.979; P = 0.001) was independently correlated with graft occlusion, with an optimal cutoff value of -79.39 HU.RCA FAI added incremental prognostic value beyond clinical characteristics for patients following CABG (AUC 0.784 vs. 0.677, P = 0.027). The RCA FAI can serve as a crucial predictor for graft occlusion in patients following CABG, enabling early identification of high-risk individuals and facilitating timely and effective intervention measures to enhance patient prognosis.

Huang S ，Yu X ，Yang B ，Xu T ，Gu H ，Wang X ... -  《-》

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》

Incremental prognostic value of pericoronary adipose tissue attenuation beyond conventional features in patients with nonobstructive coronary artery disease.

It remains uncertain whether pericoronary adipose tissue attenuation (PCATa) is associated with clinical outcome in patients with nonobstructive coronary artery disease (CAD). We aim to investigate the incremental prognostic value of PCATa beyond clinical and coronary computed tomographic angiography (CCTA) features in patients with nonobstructive CAD. Consecutive patients with chest pain suspected of CAD referred for CCTA from January 2017 to December 2018 were prospectively included. Multivariable Cox proportional hazard regression analysis was employed to identify the predictive factors for major adverse cardiovascular events (MACE), while the receiver operating characteristics (ROC) curve was utilized to assess the discriminatory capacity of PCATa. Kaplan-Meier curves were ultilized to visually represent event-free survival and were compared using Log-rank tests among groups stratified by high-risk plaque (HRP) and PCATa. Of the 1614 patients (mean age 59.0 years, 55.6 % male) with nonobstructive CAD, 68 (4.2 %) suffered MACE during a median follow-up of 28.6 months. After multivariable adjustment, PCATa was identified as an independent predictor (HR: 1.060, 95%CI: 1.025-1.096, p = 0.001). The inclusion of PCATa significantly enhanced the discrimination capacity [AUC:0.72 (0.66-0.78), p = 0.041] and risk reclassification (NRI = 1.99, p < 0.001; IDI = 0.93, p < 0.001) beyond the influence of clinical and CCTA factors. In the presence of HRP, a higher PCATa was found to be associated with a relatively higher risk of MACE compared to a lower PCATa (HR: 2.45, 95%CI: 1.09-5.52, p = 0.031). PCATa is positively correlated with adverse outcome in patients with nonobstructive CAD, and it offers incremental predictive value beyond clinical variables and CCTA characteristics.

Zheng N ，Liu Z ，Ding Y ，Wang X ，Li J ，Dou G ，Xin R ，Guo Z ，Chen G ，Jing J ，He B ，Shan D ，Yang J ... -  《-》

Quantitative plaque characteristics and pericoronary fat attenuation index enhance risk prediction of unstable angina in nonobstructive lesions.

The role of quantitative plaque characterization and pericoronary fat attenuation index (FAI) in nonobstructive lesions is uncertain. Hence, this study aimed to investigate artificial intelligence (AI)-based plaque characterization and pericoronary FAI in patients with nonobstructive lesions to enhance risk prediction of unstable angina. This study was conducted using the clinical data of 408 patients with cardiovascular disease diagnosed with angina pectoris. A coronary computed tomography angiography examination was performed, and quantitative plaque characteristics and pericoronary FAI were analyzed. Of the 408 patients with angina, 130 had nonobstructive lesions and 278 had obstructive ones. No significant difference in pericoronary FAI was observed between patients with nonobstructive and obstructive lesions. In patients with nonobstructive lesions, the plaque length and pericoronary FAI were significantly higher in patients with unstable angina than in those with stable angina. In patients with obstructive lesions, the plaque fibrolipid volume and percentage were significantly higher in patients with unstable angina than in those with stable angina, and the narrowest lumen area was significantly smaller. Left anterior descending peripheral (peri-LAD) FAI > -83 HU or total plaque length >20.17 mm were independent predictors of unstable angina in patients with nonobstructive lesions. In patients with obstructive lesions, peri-LAD FAI > -77 HU, total lipid volume >12.6 mm3, and narrowest lumen area ≤2.25 mm2 were independent predictors of unstable angina. Pericoronary FAI and total plaque length may be suitable imaging biomarkers for AI-based prediction of the occurrence of unstable angina in patients with nonobstructive lesions.

Li D ，Li H ，Wang Y ，Zhu T ... -  《-》