Abstract
Background: The association between abnormal invasive fractional flow reserve (FFR) and the fat attenuation index (FAI) of lesion-specific peri-coronary adipose tissue (PCAT) is unclear.Method: Data of patients who underwent coronary computed tomography angiography (CTA) and subsequent invasive coronary angiography (ICA) and FFR measurement within 1 week were retrospectively included. Lesion-specific FAI (FAIlesion), lesion-free FAI (FAInormal), epicardial adipose tissue (EAT) volume and attenuation was collected, along with stenosis severity and plaque characteristics. Lesions with FFR <0.8 were considered functionally significant. The association between FFR and each parameter was analyzed by logistic regression or receiver operating characteristic curve.Result: A total of 227 patients from seven centers were included. EAT volume or attenuation, traditional risk factors, and FAInormal (with vs. without ischemia: −82 ± 11 HU vs. −81 ± 11 HU, p = 0.65) were not significantly different in patients with or without abnormal FFR. In contrast, lesions causing functional ischemia presented more severe stenosis, greater plaque volume, and higher FAIlesion (with vs. without ischemia: −71 ± 8 HU vs. −76 ± 9 HU, p < 0.01). Additionally, the CTA-assessed stenosis severity (OR 1.06, 95%CI 1.04–1.08, p < 0.01) and FAIlesion (OR 1.08, 95%CI 1.04–1.12, p < 0.01) were determined to be independent factors that could predict ischemia. The combination model of these two CTA parameters exhibited a diagnostic value similar to the invasive coronary angiography (ICA)-assessed stenosis severity (AUC: 0.820 vs. 0.839, p = 0.39).Conclusion: It was FAIlesion, not general EAT parameters, that was independently associated with abnormal FFR and the diagnostic performance of CTA-assessed stenosis severity for functional ischemia was significantly improved in combination with FAIlesion.
Highlights
The presence of coronary artery disease (CAD), the presence of a flow-limiting lesion, is a primary reason for the onset of myocardial ischemia
There were 238 vessels of these patients that had intermediate lesions (a 30–90% lumen stenosis identified by invasive coronary angiography (ICA)) and the fractional flow reserve (FFR) measurement was applied in these vessels
In the FFR < 0.8 FFR ≥ 0.8 P-value multivariate analysis that included coronary CTA parameters, we found that severity of stenosis and FAIlesion were independently associated with abnormal FFR (Table 3)
Summary
The presence of coronary artery disease (CAD), the presence of a flow-limiting lesion, is a primary reason for the onset of myocardial ischemia. CTAderived fractional flow reserve (FFRCT) had been proved to significantly improve diagnostic accuracy for the detection of ischemia-causing lesions and is recommended to evaluate the functional significance of intermediate stenosis (30–90%) to help guide invasive coronary angiography (ICA) referral and revascularization treatment planning [3,4,5]. According to the Computed Tomographic Evaluation of Atherosclerotic Determinants of Myocardial Ischemia (CREDENCE) trail, the addition of FFRCT to plaque features (percentage of non-calcified atheroma volume, lumen volume, and high-risk plaque features) and stenosis severity did not improve the predictive ability of CTA on FFR abnormal [6]. The association between abnormal invasive fractional flow reserve (FFR) and the fat attenuation index (FAI) of lesion-specific peri-coronary adipose tissue (PCAT) is unclear
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