Abstract
Introduction: Chronic inflammation is focused as a cause of heart failure (HF). Pericoronary fat attenuation index (FAI) assessed on coronary CT angiography (CCTA), a maker of vascular inflammation, is reported to associate with risk of cardiac mortality. However, relationship between pericoronary FAI and development of HF has not been fully elucidated. Hypothesis: Pericoronary FAI predicts hospitalization for HF. Methods: A total of 1196 consecutive patients who underwent clinically indicated CCTA and transthoracic echocardiography for suspected CAD were enrolled. Patients with a history of CAD, hospitalization for HF, left ventricular ejection fraction (LVEF) <40%, and hemodialysis were excluded. We assessed pericoronary FAI of proximal 40 mm segments for three major coronary arteries. Association between pericoronary FAI and incidence of hospitalization for HF was analyzed by Cox regression analysis. Results: During a median follow-up of 4.3 years, 29 hospitalizations for HF occurred. Pericoronary FAI of three major coronary arteries were significantly corelated each other. Pericoronary FAI of left anterior descending artery (LAD) was higher in patients with hospitalization for HF than in patients without hospitalization for HF (-61.4 ± 7.8 HU and -67.4 ± 7.2 HU, p<0.001). Optimal cut-off value of pericoronary FAI of LAD for predicting hospitalization for HF was -64.8 HU. Pericoronary FAI of LAD (>-64.8 HU) was significantly associated with hospitalization for HF after adjusted by age and gender (HR 4.77, 95%CI 2.10-10.81). In addition, these analyses were performed in 885 patients without significant stenosis (16 hospitalizations for HF occurred). In this cohort, pericoronary FAI of LAD in patients with hospitalization for HF was higher than that in patients without hospitalization for HF (-60.8 ± 7.2 HU and -67.3 ± 7.2 HU, p<0.001), and association of FAI of LAD with hospitalization for HF remained significant. Pericoronary FAI of LAD was significantly correlated with left atrial volume index, left ventricular mass index, LVEF and E/e’, respectively (p<0.001). Conclusions: Pericoronary FAI of LAD on CCTA may be a useful clinical predictor of hospitalization for HF in patients suspected CAD without history of CAD and hospitalization for HF.
Published Version
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