Dong Jie, Yu Jinxin, Zhao Yang, Fengfeng Yang
NHC Key Lab of Hormones and Development and Tianjin Key Lab of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital & Institute of Endocrinology.
Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, China.
J Comput Assist Tomogr. 2025;49(5):737-744. doi: 10.1097/RCT.0000000000001749. Epub 2025 Mar 10.
This study aimed to evaluate the clinical value of the fat attenuation index (FAI) of pericoronary adipose tissue (PCAT) and fractional flow reserve derived from coronary computed tomography angiography (CT-FFR) in predicting coronary revascularization.
Patients with known or suspected acute coronary syndrome (ACS) who underwent coronary computed tomography angiography (CCTA) and subsequent invasive coronary angiography (ICA) were screened. FAI, lesion-specific CT-FFR, and distal-tip CT-FFR were analyzed by core laboratories blinded to patient management. Per-vessel and per-patient logistic univariable and multivariable analyses were performed to predict revascularization. Three multivariable logistic regression models were compared, with ROC curves generated for each model and AUCs compared. Incremental predictive value between models 2 and 3 was also measured using continuous net reclassification improvement (NRI).
A total of 94 patients who received CCTA followed by ICA were identified and analyzed; 282 vessels were included. Overall, 54 (57.4%) patients with 72 (25.5%) vessels underwent revascularization. Lesion-specific CT-FFR, FAI, and significant stenosis were significantly associated with revascularization in both univariable and multivariable analyses. Lesion-specific CT-FFR, FAI, and significant stenosis were independent predictors of coronary revascularization. In the per-vessel analysis, those with 2 or 3 risk factors had a markedly higher revascularization rate [50 of 69 (72.5%) vs. 22 of 213 (10.3%); P < 0.001]. In the per-patient analysis, those with 2 or 3 risk factors had a markedly higher revascularization rate [35 of 42 (83.3%) vs. 19 of 52 (36.5%); P < 0.001]. The continuous net reclassification improvement (NRI) for the addition of FAI and CT-FFR to standard CCTA analysis (model 3 over model 2) was 0.273 (95% CI, 0.166-0.379, P < 0.0001).
This study demonstrated the application value of CT-FFR and FAI in predicting coronary revascularization in patients with documented ACS. CT-FFR and FAI obtained from quantitative CCTA improved the prediction of future revascularization. These parameters can potentially identify patients likely to receive revascularization upon referral for cardiac catheterization. However, the clinical use of FAI may be limited by the lack of standardization in PCAT values and the absence of a clear established cutoff for clinical relevance.
本研究旨在评估冠状动脉周围脂肪组织（PCAT）的脂肪衰减指数（FAI）和冠状动脉计算机断层扫描血管造影（CT-FFR）衍生的血流储备分数在预测冠状动脉血运重建方面的临床价值。
筛选出接受冠状动脉计算机断层扫描血管造影（CCTA）及随后侵入性冠状动脉造影（ICA）的已知或疑似急性冠状动脉综合征（ACS）患者。由对患者管理不知情的核心实验室分析FAI、病变特异性CT-FFR和远端CT-FFR。进行血管和患者层面的逻辑单变量和多变量分析以预测血运重建。比较三个多变量逻辑回归模型，为每个模型生成ROC曲线并比较AUC。还使用连续净重新分类改善（NRI）测量模型2和模型3之间的增量预测价值。
共纳入并分析了94例接受CCTA后行ICA的患者；包含282支血管。总体而言，54例（57.4%）患者的72支血管（25.5%）接受了血运重建。在单变量和多变量分析中，病变特异性CT-FFR、FAI和显著狭窄均与血运重建显著相关。病变特异性CT-FFR、FAI和显著狭窄是冠状动脉血运重建的独立预测因素。在血管层面分析中，有2个或3个危险因素的患者血运重建率明显更高[69例中的50例（72.5%） vs. 213例中的22例（10.3%）；P < 0.001]。在患者层面分析中，有2个或3个危险因素的患者血运重建率明显更高[42例中的35例（83.3%） vs. 52例中的19例（36.5%）；P < 0.001]。将FAI和CT-FFR添加到标准CCTA分析中（模型3相对于模型2）的连续净重新分类改善（NRI）为0.273（95%CI，0.166 - 0.379，P < 0.0001）。
本研究证明了CT-FFR和FAI在预测已确诊ACS患者冠状动脉血运重建方面的应用价值。从定量CCTA获得的CT-FFR和FAI改善了对未来血运重建的预测。这些参数可能有助于识别在转诊进行心导管检查时可能接受血运重建的患者。然而，FAI的临床应用可能受到PCAT值缺乏标准化以及缺乏明确的临床相关临界值的限制。
