Abstract
AimsPerivascular fat attenuation index (FAI) has emerged as a novel coronary computed tomography angiography (CCTA)–based biomarker predicting cardiovascular outcomes by capturing early coronary inflammation. It is currently unknown whether FAI adds prognostic value beyond that provided by single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) and CCTA findings including coronary artery calcium scoring (CACS).Methods and resultsA total of 492 patients (mean age 62.5 ± 10.8 years) underwent clinically indicated multimodality CCTA and electrocardiography (ECG)-gated 99mTc-tetrofosmin SPECT-MPI between May 2005 and December 2008 at our institution, and follow-up data on major adverse cardiovascular events (MACE) was obtained for 314 patients. FAI was obtained from CCTA images and was measured around the right coronary artery (FAI[RCA]), the left anterior descending artery (FAI[LAD]), and the left main coronary artery (FAI[LMCA]). During a median follow-up of 2.7 years, FAI[RCA] > − 70.1 was associated with an increased rate of MACE (log rank p = 0.049), while no such association was seen for FAI[LAD] or FAI[LMCA] (p = NS). A multivariate Cox regression model accounting for cardiovascular risk factors, CCTA and SPECT-MPI findings identified FAI[RCA] as an independent predictor of MACE (HR 2.733, 95% CI: 1.220–6.123, p = 0.015). However, FAI[RCA] was no longer a significant predictor of MACE after adding CACS (p = 0.279). A first-order interaction term consisting of sex and FAI[RCA] was significant in both models (HR 2.119, 95% CI: 1.218–3.686, p = 0.008; and HR 2.071, 95% CI: 1.111–3.861, p = 0.022).ConclusionFAI does not add incremental prognostic value beyond multimodality MPI/CCTA findings including CACS. The diagnostic value of FAI[RCA] is significantly biased by sex.
Highlights
Mapping of perivascular fat surrounding the coronary arteries was proposed as a tool for early non-invasive detection of coronary inflammation
The adipogenesis of immature preadipocytes is promoted by peroxisome proliferatoractivated receptor (PPAR)-γ activation; this mechanism is substantially inhibited by exogenous inflammation in the surrounding vasculature, which can be measured by routine coronary computed tomography angiography (CCTA)
We assessed whether fat attenuation index (FAI) adds incremental information gain for predicting major adverse cardiovascular events (MACE) beyond that provided by singlephoton emission computed tomography (SPECT)-myocardial perfusion imaging (MPI) and CCTA findings in women and men undergoing cardiac multimodality imaging
Summary
Mapping of perivascular fat surrounding the coronary arteries was proposed as a tool for early non-invasive detection of coronary inflammation. The perivascular fat attenuation index (FAI) was recently developed as a CCTA-derived imaging metric that can detect coronary inflammation and has demonstrated a prognostic value in the early detection of adverse cardiovascular events [2]. It has been reported that perivascular FAI improves cardiac risk prediction over conventional CCTA prompting significant patient reclassification for cardiac and all-cause mortality [2] It is currently unknown whether FAI quantification adds a prognostic value as an adjunct to nuclear myocardial perfusion imaging (MPI) and cardiac multimodality imaging comprising 99mTc-tetrofosmine singlephoton emission computed tomography (SPECT)-MPI and CCTA. It remains elusive whether women and men benefit from FAI quantification. We assessed whether FAI adds incremental information gain for predicting major adverse cardiovascular events (MACE) beyond that provided by SPECT-MPI and CCTA findings in women and men undergoing cardiac multimodality imaging
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