Diagnostic performance of perivascular fat attenuation index to predict hemodynamic significance of coronary stenosis: a preliminary coronary computed tomography angiography study

Yu, Meijuan; Xu, Da-Zhong; Deng, Jianhong; Lu, Zhigang; Shen, Chengxing; Zhang, Jiayin

doi:10.1007/s00330-019-06400-8

Cited by 53 publications

(67 citation statements)

References 31 publications

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“…Studies found that PCAT MA and FFR were related at the per-vessel level [20] and that PCAT MA of RCA was able to assist in risk stratification of cardiovascular mortality [25]. The combined use of PCAT MA , total plaque volume, and diameter stenosis has shown high diagnostic accuracy for prediction of hemodynamically significant coronary stenosis [24]. Interestingly, Goeller et al [21] found that changes in attenuation of adipose tissue in the pericoronary space were related to changes in plaque burden.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the focus has shifted to the identification of segments at future risk of developing potentially vulnerable plaque [ 26 ]. Studies on PCAT MA in diseased populations showed significant differences between diseased and non-diseased coronary arteries, and between flow-limiting and non-flow limiting stenosis [ 24 ]. Although results were statistically significant, these studies show, similar to the current study, limited absolute differences in PCAT values (± 5 HU).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, PCAT could potentially be used as a non-invasive proxy to assess coronary inflammation based on routine cCTA imaging, and could offer valuable information for early diagnosis, treatment, and prevention of CAD. Several studies explored the diagnostic value of PCAT MA in patients with plaques [20][21][22][23][24]. However, studies including patients without plaque so far mainly focused on the healthy RCA in small cohorts of patients.…”

Section: Introductionmentioning

confidence: 99%

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Towards reference values of pericoronary adipose tissue attenuation: impact of coronary artery and tube voltage in coronary computed tomography angiography

Ties

Assen

et al. 2020

Eur Radiol

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Objectives To determine normal pericoronary adipose tissue mean attenuation (PCATMA) values for left the anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) in patients without plaques on coronary CT angiography (cCTA), taking into account tube voltage influence. Methods This retrospective study included 192 patients (76 (39.6%) men; median age 49 years (range, 19–79)) who underwent cCTA with third-generation dual-source CT for the suspicion of CAD between 2015 and 2017. We selected patients without plaque on cCTA. PCATMA was measured semi-automatically on cCTA images in the proximal segment of the three main coronary arteries with 10 mm length. Paired t-testing was used to compare PCATMA between combinations of two coronary arteries within each patient, and one-way ANOVA testing was used to compare PCATMA in different kV groups. Results The overall mean ± standard deviation (SD) PCATMA was − 90.3 ± 11.1 HU. PCATMA in men was higher than that in women: − 88.5 ± 10.5 HU versus − 91.5 ± 11.3 HU (p = 0.001). PCATMA of LAD, LCX, and RCA was − 92.4 ± 11.6 HU, − 88.4 ± 9.9 HU, and − 90.2 ± 11.4 HU, respectively. Pairwise comparison of the arteries showed significant difference in PCATMA: LAD and LCX (p < 0.001), LAD and RCA (p = 0.009), LCX and RCA (p = 0.033). PCATMA of the 70 kV, 80 kV, 90 kV, 100 kV, and 120 kV groups was − 95.6 ± 9.6 HU, − 90.2 ± 11.5 HU, − 87.3 ± 9.9 HU, − 82.7 ± 6.2 HU, and − 79.3 ± 6.8 HU, respectively (p < 0.001). Conclusions In patients without plaque on cCTA, PCATMA varied by tube voltage, with minor differences in PCATMA between coronary arteries (LAD, LCX, RCA). PCATMA values need to be interpreted taking into account tube voltage setting. Key Points • In patients without plaque on cCTA, PCATMAdiffers slightly by coronary artery (LAD, LCX, RCA). • Tube voltage of cCTA affects PCATMAmeasurement, with mean PCATMAincreasing linearly with increasing kV. • For longitudinal cCTA analysis of PCATMA, the use of equal kV setting is strongly recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Towards reference values of pericoronary adipose tissue attenuation: impact of coronary artery and tube voltage in coronary computed tomography angiography

Ties

Assen

et al. 2020

Eur Radiol

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“…of an abnormally elevated FAI, HRP features identified a truly "high-risk" population with a 6.26-fold higher adjusted cardiac risk level compared with the low-FAI and HRP-negative reference group (40). Interestingly, recent evidence suggests that the perivascular FAI is also linked to functional characteristics of the adjacent coronary lesions, with new studies showing that higher coronary inflammation measured using perivascular fat attenuation is related with lower CT-derived fractional flow reserve values (41,42). Taken together, these findings suggest that vascular inflammation measured by this method is closely linked to adverse plaque remodeling and its hemodynamic consequences.…”

Section: Perivascular Fai Mapping As a Recently Developed Dimension Imentioning

confidence: 99%

Assessing Cardiovascular Risk by Using the Fat Attenuation Index in Coronary CT Angiography

Klüner¹,

Oikonomou

Antoniades³

2021

Radiology: Cardiothoracic Imaging

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Coronary CT angiography (CCTA) has evolved into a first-line diagnostic test for the investigation of chest pain. Despite advances toward standardizing the reporting of CCTA through the Coronary Artery Disease Reporting and Data System (or CAD-RADS) tool, the prognostic value of CCTA in the earliest stages of atherosclerosis remains limited. Translational work on the bidirectional interplay between the coronary arteries and the perivascular adipose tissue (PVAT) has highlighted PVAT as an in vivo molecular sensor of coronary inflammation. Coronary inflammation is dynamically associated with phenotypic changes in its adjacent PVAT, which can now be detected as perivascular attenuation gradients at CCTA. These gradients are captured and quantified through the fat attenuation index (FAI), a CCTA-based biomarker of coronary inflammation. FAI carries significant prognostic value in both primary and secondary prevention (patients with and without established coronary artery disease) and offers a significant improvement in cardiac risk discrimination beyond traditional risk factors, such as coronary calcium, high-risk plaque features, or the extent of coronary atherosclerosis. Thanks to its dynamic nature, FAI may be used as a marker of disease activity, with observational studies further suggesting that it tracks the response to anti-inflammatory interventions. Finally, radiotranscriptomic studies have revealed complementary radiomic patterns of PVAT, which detect more permanent adverse fibrotic and vascular PVAT remodeling, further expanding the value of PVAT phenotyping as an important readout in modern CCTA analysis.

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“…PCAT MA has shown value as a predictor for cardiac mortality [6]. Few studies, predominantly using the proximal right coronary artery (RCA) as a representative location for patient-level analysis, have shown a relationship of PCAT MA with CAD and atherosclerosis progression [5,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Focal pericoronary adipose tissue attenuation is related to plaque presence, plaque type, and stenosis severity in coronary CTA

Assen

Ties

et al. 2021

Eur Radiol

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Objectives To investigate the association of pericoronary adipose tissue mean attenuation (PCATMA) with coronary artery disease (CAD) characteristics on coronary computed tomography angiography (CCTA). Methods We retrospectively investigated 165 symptomatic patients who underwent third-generation dual-source CCTA at 70kVp: 93 with and 72 without CAD (204 arteries with plaque, 291 without plaque). CCTA was evaluated for presence and characteristics of CAD per artery. PCATMA was measured proximally and across the most severe stenosis. Patient-level, proximal PCATMA was defined as the mean of the proximal PCATMA of the three main coronary arteries. Analyses were performed on patient and vessel level. Results Mean proximal PCATMA was −96.2 ± 7.1 HU and −95.6 ± 7.8HU for patients with and without CAD (p = 0.644). In arteries with plaque, proximal and lesion-specific PCATMA was similar (−96.1 ± 9.6 HU, −95.9 ± 11.2 HU, p = 0.608). Lesion-specific PCATMA of arteries with plaque (−94.7 HU) differed from proximal PCATMA of arteries without plaque (−97.2 HU, p = 0.015). Minimal stenosis showed higher lesion-specific PCATMA (−94.0 HU) than severe stenosis (−98.5 HU, p = 0.030). Lesion-specific PCATMA of non-calcified, mixed, and calcified plaque was −96.5 HU, −94.6 HU, and −89.9 HU (p = 0.004). Vessel-based total plaque, lipid-rich necrotic core, and calcified plaque burden showed a very weak to moderate correlation with proximal PCATMA. Conclusions Lesion-specific PCATMA was higher in arteries with plaque than proximal PCATMA in arteries without plaque. Lesion-specific PCATMA was higher in non-calcified and mixed plaques compared to calcified plaques, and in minimal stenosis compared to severe; proximal PCATMA did not show these relationships. This suggests that lesion-specific PCATMA is related to plaque development and vulnerability. Key Points • In symptomatic patients undergoing CCTA at 70 kVp, PCATMAwas higher in coronary arteries with plaque than those without plaque. • PCATMAwas higher for non-calcified and mixed plaques compared to calcified plaques, and for minimal stenosis compared to severe stenosis. • In contrast to PCATMAmeasurement of the proximal vessels, lesion-specific PCATMAshowed clear relationships with plaque presence and stenosis degree.

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Diagnostic performance of perivascular fat attenuation index to predict hemodynamic significance of coronary stenosis: a preliminary coronary computed tomography angiography study

Cited by 53 publications

References 31 publications

Towards reference values of pericoronary adipose tissue attenuation: impact of coronary artery and tube voltage in coronary computed tomography angiography

Towards reference values of pericoronary adipose tissue attenuation: impact of coronary artery and tube voltage in coronary computed tomography angiography

Assessing Cardiovascular Risk by Using the Fat Attenuation Index in Coronary CT Angiography

Focal pericoronary adipose tissue attenuation is related to plaque presence, plaque type, and stenosis severity in coronary CTA

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