Antoniades Charalambos, Antonopoulos Alexios S, Deanfield John
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK.
UCL Institute of Cardiovascular Science, London, UK.
Eur Heart J. 2020 Feb 1;41(6):748-758. doi: 10.1093/eurheartj/ehz474.
Targeting residual cardiovascular risk in primary and secondary prevention, would allow deployment of novel therapeutic agents, facilitating precision medicine. For example, lowering vascular inflammation is a promising strategy to reduce the residual inflammatory cardiovascular risk in patients already receiving optimal medical therapy, but prescribing novel anti-inflammatory treatments will be problematic due to the lack of specific companion diagnostic tests, to guide their targeted use in clinical practice. Currently available tests for the detection of coronary inflammation are either non-specific for the cardiovascular system (e.g. plasma biomarkers) or expensive and not readily available (e.g. hybrid positron emission tomography imaging). Recent technological advancements in coronary computed tomography angiography (CCTA) allow non-invasive detection of high-risk plaque features (positive remodelling, spotty calcification, low attenuation plaque, and napkin-ring sign) and help identify the vulnerable patient, but they provide only indirectly information about coronary inflammation. Perivascular fat attenuation index (FAI), a novel method for assessing coronary inflammation by analysing routine CCTA, captures changes in the perivascular adipose tissue composition driven by inflammatory signals coming from the inflamed coronary artery, by analysing the three-dimensional gradients of perivascular attenuation, followed by adjustments for technical, anatomical, and biological factors. By detecting vascular inflammation, perivascular FAI enhances cardiovascular risk discrimination which could aid more cost-effective deployment of novel therapeutic agents. In this article, we present the existing non-invasive modalities for the detection of coronary inflammation and provide a practical guide for their use in clinical practice.
针对一级和二级预防中的残余心血管风险，将有助于新型治疗药物的应用，推动精准医学的发展。例如，降低血管炎症是一种很有前景的策略，可降低已接受最佳药物治疗的患者残余的炎症性心血管风险，但由于缺乏特定的伴随诊断测试来指导其在临床实践中的靶向使用，开具新型抗炎治疗药物会存在问题。目前用于检测冠状动脉炎症的测试，要么对心血管系统不具有特异性（如血浆生物标志物），要么昂贵且不易获得（如混合正电子发射断层扫描成像）。冠状动脉计算机断层扫描血管造影（CCTA）的最新技术进展，能够非侵入性地检测高危斑块特征（正性重构、斑点状钙化、低衰减斑块和餐巾环征），并有助于识别易损患者，但它们仅间接提供有关冠状动脉炎症的信息。血管周围脂肪衰减指数（FAI）是一种通过分析常规CCTA评估冠状动脉炎症的新方法，它通过分析血管周围衰减的三维梯度，然后对技术、解剖和生物学因素进行调整，捕捉由发炎冠状动脉发出的炎症信号驱动的血管周围脂肪组织成分变化。通过检测血管炎症，血管周围FAI增强了心血管风险判别能力，这有助于更具成本效益地应用新型治疗药物。在本文中，我们介绍了现有的用于检测冠状动脉炎症的非侵入性方法，并为其在临床实践中的应用提供实用指南。
