Quantification of perivascular inflammation does not provide incremental prognostic value over myocardial perfusion imaging and calcium scoring

Abstract

Aims Perivascular fat attenuation index (FAI) has emerged as a novel coronary computed tomography angiography (CCTA)–based biomarker predicting cardiovascular outcomes by capturing early coronary inflammation. It is currently unknown whether FAI adds prognostic value beyond that provided by single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) and CCTA findings including coronary artery calcium scoring (CACS). Methods and results A total of 492 patients (mean age 62.5 ± 10.8 years) underwent clinically indicated multimodality CCTA and electrocardiography (ECG)-gated 99mTc-tetrofosmin SPECT-MPI between May 2005 and December 2008 at our institution, and follow-up data on major adverse cardiovascular events (MACE) was obtained for 314 patients. FAI was obtained from CCTA images and was measured around the right coronary artery (FAI[RCA]), the left anterior descending artery (FAI[LAD]), and the left main coronary artery (FAI[LMCA]). During a median follow-up of 2.7 years, FAI[RCA] > − 70.1 was associated with an increased rate of MACE (log rank p = 0.049), while no such association was seen for FAI[LAD] or FAI[LMCA] (p = NS). A multivariate Cox regression model accounting for cardiovascular risk factors, CCTA and SPECT-MPI findings identified FAI[RCA] as an independent predictor of MACE (HR 2.733, 95% CI: 1.220–6.123, p = 0.015). However, FAI[RCA] was no longer a significant predictor of MACE after adding CACS (p = 0.279). A first-order interaction term consisting of sex and FAI[RCA] was significant in both models (HR 2.119, 95% CI: 1.218–3.686, p = 0.008; and HR 2.071, 95% CI: 1.111–3.861, p = 0.022). Conclusion FAI does not add incremental prognostic value beyond multimodality MPI/CCTA findings including CACS. The diagnostic value of FAI[RCA] is significantly biased by sex.

Role of cardiac CT in the diagnostic evaluation and risk stratification of patients with myocardial infarction and non-obstructive coronary arteries (MINOCA): rationale and design of the MINOCA-GR study

“…The ability of CCTA to evaluate the entire coronary vessel for atherosclerosis (as compared with only segmental approach by IVUS or OCT) is crucial to identify and predict ischaemia 37–39. In addition, CCTΑ can now be used for the evaluation of pericoronary fat tissue with valuable prognostic implications 14 15 40. Recent advances in artificial intelligence and deep learning,41 may result in a reduction of radiation dose during CCTA.…”

“… 25 Pericoronary fat attenuation measurements will be carried out by a semiautomated analysis using PMOD V.3.805 (PMOD Technologies, Zurich, Switzerland), as previously reported. 15 …”

“…Finally, total atherosclerotic plaque burden will be assessed on a perpatient basis using previous scoring systems such as Leiden CTA risk score,23 CT-adapted Gensini score,24 segment involvement score and segment severity score 25. Pericoronary fat attenuation measurements will be carried out by a semiautomated analysis using PMOD V.3.805 (PMOD Technologies, Zurich, Switzerland), as previously reported 15…”

“…25 Pericoronary fat attenuation measurements will be carried out by a semiautomated analysis using PMOD V.3.805 (PMOD Technologies, Zurich, Switzerland), as previously reported. 15 Infarct-related artery analysis For each patient, a feeding coronary artery will be assigned to each myocardial segment on the basis of the American Heart Association recommendations 26 by independent investigators, blinded to the results of CMR. An infarct-related artery (IRA) on the basis of LGE distribution and myocardial oedema will then be identified.…”

“…Apart from detecting coronary artery anomalies, stenosis and myocardial bridges,13 CCTA has a suite of strengths in the identification of vulnerable plaque features and total atherosclerotic plaque burden. Importantly, CCTA can identify pericoronary fat attenuation and local inflammation,14 15 the role of which has not been well studied in MINOCA. As a result, CCTA combined with CMR could assist with non-invasive identification of the pathophysiological mechanism, risk stratification and prognosis of MINOCA patients.…”