CT-derived modified Duke score is associated with pericoronary Fat Attenuation Index and predicts severity of coronary inflammation

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The IntelFat project - "Epicardic adipose tissue, local inflammation and the vulnerability of atherosclerotic plaques - computational imaging study based on artificial intelligence" financed by UEFISCDI 689/02.03.2021 (Contract number 206/2021). Background The modified Duke derived from coronary computed tomography angiography (CCTA) was designed to predict cardiovascular outcomes based on the severity of coronary stenosis. However, it does not take into consideration the presence or severity of peri-coronary inflammation. The peri-coronary fat attenuation index (FAI) is a novel imaging marker determined by CCTA which reflects the degree of inflammation in the coronary tree in patients with coronary artery disease. Purpose To assess the association between the modified Duke score assessed by CCTA, cardiovascular risk factors and peri-coronary FAI in the coronary arteries. Methods One hundred sixty-nine patients who underwent CCTA for typical angina were assigned into two groups based on the modified Duke score: group 1 – patients with low score ≤ 3 (n=105) and group 2 – patients with high score > 3 (n=64). Demographic data, cardiovascular risk factors (hypertension, hypercholesterolemia, diabetes and smoking), and the FAI-score for all three coronary arteries were collected for all patients. Results Patients with increased values of the modified Duke score were significantly older compared to those with a low score (64.5 ± 8.75 vs. 61.0 ± 10.12; p = 0.001). No differences were found between the two groups in terms of gender distribution, hypertension, hypercholesterolemia or smoking history (all p > 0.5). Compared to patients in group 1, those in group 2 presented more frequently type 2 diabetes, (54.35% vs. 45.65%; p = 0.008). FAI score was significantly higher in patients from group 2, who presented a significantly higher score of inflammation compared to the patients in group 1, especially at the level of the right coronary artery (FAI score 16.45 ± 15.83 vs. 10.6 ± 14.09; p = 0.02 for the right coronary artery, 12.72 ± 8.05 vs. 9.6 ± 6.56; p = 0.01 for the circumflex artery, and 10.35 ±10.18 vs. 8.7 ± 8.89; p = 0.18 for the left anterior descending artery). Conclusion(s) CT-derived modified Duke score is increased in patients with DM and correlates well with local perilesional inflammation, as assessed by the FAI score at different levels of the coronary circulation.