Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
J Cardiovasc Comput Tomogr. 2020 Nov-Dec;14(6):483-489. doi: 10.1016/j.jcct.2020.02.002. Epub 2020 Feb 6.
Peri-coronary adipose tissue attenuation expressed by fat attenuation index (FAI) on coronary CT angiography (CCTA) reflects peri-coronary inflammation and is associated with cardiac mortality. We aimed to investigate the association between FAI and whole vessel and lesion plaque quantification on CCTA in stable patients with intermediate epicardial stenosis evaluated by fractional flow reserve (FFR).
A total of 187 left anterior descending arteries (LAD) with intermediate stenosis who underwent FFR measurement and CCTA were studied. FAI was assessed by the crude analysis of the mean CT attenuation value of LAD on CCTA. Determinants of FAI and FFR were explored. Furthermore, the impact of combined baseline data, CCTA-derived lesion plaque assessment, whole vessel quantification, cardiac mass and FAI on discrimination efficacy for ischemia was evaluated as FFR used for a reference standard.
The mean FAI and the median FFR values were -73.0 and 0.77, respectively. Multivariate analysis revealed that male, CCTA-derived positive remodeling, lower minimum lumen area, higher target vessel total cardiac mass, and lower FFR were independent predictors of FAI. CCTA-derived two-dimensional and three-dimensional analysis and FAI were independently and significantly associated with FFR values. Net reclassification index and integrated discrimination improvement index were both significantly improved when FAI was added to the baseline model for lesions with FFR <0.75, but not for FFR≤0.80.
FAI was associated with FFR, CCTA-derived two-dimensional and three-dimensional lumen and plaque quantification and cardiac mass in patients with intermediate lesions in LAD, indicating that comprehensive CTA assessment may provide risk-stratification.
冠状动脉 CT 血管造影（CCTA）上的脂肪衰减指数（FAI）所表示的冠状动脉周围脂肪衰减反映了冠状动脉周围炎症，并与心脏死亡率相关。我们旨在研究在通过血流储备分数（FFR）评估的稳定型中间节段心外膜狭窄患者中，FAI 与 CCTA 上的全血管和病变斑块定量之间的关系。
共研究了 187 例接受 FFR 测量和 CCTA 的左前降支（LAD）中段狭窄患者。通过对 CCTA 上 LAD 的平均 CT 衰减值进行粗略分析来评估 FAI。探讨了 FAI 和 FFR 的决定因素。此外，还评估了基线数据、CCTA 衍生的病变斑块评估、全血管定量、心脏质量和 FAI 等综合因素，以及 FAI 对缺血的鉴别效能，因为 FFR 被用作参考标准。
平均 FAI 和中位数 FFR 值分别为-73.0 和 0.77。多变量分析显示，男性、CCTA 衍生的正性重构、较低的最小管腔面积、较高的靶血管总心脏质量和较低的 FFR 是 FAI 的独立预测因素。CCTA 衍生的二维和三维分析与 FAI 与 FFR 值独立且显著相关。当将 FAI 添加到 FFR<0.75 的病变的基线模型中时，净重新分类指数和综合鉴别改善指数均显著提高，但对于 FFR≤0.80 的病变则不然。
在 LAD 中段狭窄的患者中，FAI 与 FFR、CCTA 衍生的二维和三维管腔和斑块定量以及心脏质量相关，表明综合 CTA 评估可能提供风险分层。
