Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Cardiovascular surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
BMC Cardiovasc Disord. 2024 Oct 26;24(1):597. doi: 10.1186/s12872-024-04257-4.
To clarify the fat attenuation index (FAI) change trend of peri-saphenous vein graft (SVG) and determine the association between FAI and graft disease progression based on CCTA images.
Patients with venous coronary artery bypass grafts (CABGs) were consecutively enrolled in this retrospective study. In study 1, 72 patients who had undergone 1, 3, and 5 years of CCTA examinations without graft occlusion were recruited, and generalized estimation equation was used to analyze the peri-SVG FAI change trend over time. In study 2, 42 patients with graft disease progression and 84 patients as controls were propensity score-matched. Generalized linear mixed model and continuous net reclassification improvement (NRI) were used for assessing the associations with graft disease progression. Multivariable Cox regression analysis was used for assessing risk factors predicting cardiac events.
In study 1, both the FAI of proximal right coronary artery and SVG decreased over time. In study 2, the 1-year CTA-derived FAI of grafts and graft anastomosis were independent indicators of graft disease progression at the 3-year CCTA follow-up (graft: odds ratio [OR] = 1.106; 95% confidence interval [CI] = 1.030-1.188, P = 0.006; graft anastomosis: OR = 1.170, 95% CI = 1.091-1.254, P < 0.001). Inclusion of the graft anastomosis FAI significantly improved reclassification compared with graft FAI (continuous NRI = 0.638, 95% CI: 0.345-0.931, P < 0.001). Moreover, The graft anastomosis FAI was found to be a risk factor for cardiac events after CABG and no statistically significant difference was found in the graft FAI (graft anastomosis: HR = 1.158, 95% CI = 1.034-1.297, P = 0.011; graft: HR = 1.116, 95% CI = 0.995-1.251, P = 0.061).
A synchronism was found in the FAI change trend between native coronary artery and venous graft, which both decreased over time. The CCTA-derived FAI of venous grafts showed the potential of demonstrating SVG disease progression and graft anastomosis served as the optimal measured location.
为了明确围静脉吻合处（SVG）的脂肪衰减指数（FAI）变化趋势，并基于 CCTA 图像确定 FAI 与移植物病变进展的关系。
本回顾性研究连续纳入静脉冠状动脉旁路移植术（CABG）患者。在研究 1 中，招募了 72 例在无移植物闭塞的情况下接受了 1、3 和 5 年 CCTA 检查的患者，使用广义估计方程分析了 SVG 围术期 FAI 的时间变化趋势。在研究 2 中，将 42 例发生移植物病变进展的患者和 84 例对照患者进行倾向性评分匹配。使用广义线性混合模型和连续净重新分类改善（NRI）评估与移植物病变进展的相关性。多变量 Cox 回归分析用于评估预测心脏事件的危险因素。
在研究 1 中，右冠状动脉近端和 SVG 的 FAI 均随时间推移而降低。在研究 2 中，CCTA 随访 3 年时，1 年 CTA 衍生的移植物和吻合口 FAI 是移植物病变进展的独立预测指标（移植物：比值比[OR] = 1.106；95%置信区间[CI] = 1.030-1.188，P = 0.006；吻合口：OR = 1.170，95% CI = 1.091-1.254，P < 0.001）。纳入吻合口 FAI 可显著提高与移植物 FAI 相比的重新分类（连续 NRI = 0.638，95%CI：0.345-0.931，P < 0.001）。此外，吻合口 FAI 是 CABG 后心脏事件的危险因素，而移植物 FAI 则无统计学差异（吻合口：HR = 1.158，95%CI = 1.034-1.297，P = 0.011；移植物：HR = 1.116，95%CI = 0.995-1.251，P = 0.061）。
在原生冠状动脉和静脉移植物的 FAI 变化趋势中发现了同步性，两者均随时间推移而降低。CCTA 衍生的静脉移植物 FAI 显示出显示 SVG 病变进展的潜力，而吻合口是最佳测量位置。
