Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
Curr Atheroscler Rep. 2024 Dec;26(12):733-738. doi: 10.1007/s11883-024-01245-z. Epub 2024 Oct 10.
The purpose of this review is to evaluate the current state of knowledge regarding the technical challenges associated with the Post-Acquisition Fat Attenuation Index (PFAI). By examining the limitations and gaps in the current methodologies, this review aims to provide a comprehensive understanding of how various factors impact the accuracy and reliability of PFAI measurements.
PFAI correlates with plaque instability, as inflammation in coronary plaque alters surrounding adipose tissue composition, increasing its water content and reducing lipid content, which is detectable via cardiac CT as increased attenuation. Recent studies have demonstrated PFA's prognostic value, with elevated levels linked to higher risks of cardiac events and plaque instability. A 2022 meta-analysis confirmed its association with major adverse cardiac events. Machine learning algorithms incorporating PFA and additional imaging features have further enhanced risk prediction beyond traditional metrics. Pericoronary fat attenuation is a promising marker for assessing coronary inflammation and could be useful in predicting plaque development, rupture, and monitoring treatment response, though further prospective studies and technical standardization are needed to fully establish its clinical benefits.
本次综述的目的在于评估与后获取性脂肪衰减指数（PFAI）相关的技术挑战的现有知识水平。通过检查当前方法学的局限性和差距，本综述旨在全面了解各种因素如何影响 PFAI 测量的准确性和可靠性。
PFAI 与斑块不稳定性相关，因为冠状动脉斑块中的炎症会改变周围脂肪组织的组成，增加其含水量并降低脂质含量，这可通过心脏 CT 检测到衰减增加。最近的研究表明 PFA 具有预后价值，升高的水平与更高的心脏事件和斑块不稳定性风险相关。2022 年的一项荟萃分析证实了它与主要不良心脏事件的相关性。将 PFA 和其他成像特征纳入机器学习算法进一步提高了风险预测能力，超越了传统指标。冠状动脉周围脂肪衰减是评估冠状动脉炎症的有前途的标志物，可能有助于预测斑块发展、破裂以及监测治疗反应，但需要进一步的前瞻性研究和技术标准化来充分确立其临床获益。
