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. 2024 May 6;60(5):765.
doi: 10.3390/medicina60050765.

Coronary Computed Tomography Angiography-Derived Modified Duke Index Is Associated with Peri-Coronary Fat Attenuation Index and Predicts Severity of Coronary Inflammation

Vasile-Bogdan Halațiu  1   2 , Imre Benedek  2   3 , Ioana-Patricia Rodean  2   3   4 , Liliana-Oana Cojocariu  2 , Theofana Mihăilă  2   5 , Emanuel Blîndu  2   4 , Aurelian Roșca  2   3   5 , Botond-Barna Mátyás  2   5 , Renata Gerculy  2   5 , Florin Buicu  6 , Theodora Benedek  2   4
Affiliations

Coronary Computed Tomography Angiography-Derived Modified Duke Index Is Associated with Peri-Coronary Fat Attenuation Index and Predicts Severity of Coronary Inflammation

Vasile-Bogdan Halațiu et al. Medicina (Kaunas). .

Abstract

Background and Objectives: The modified Duke index 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. To assess the association between the modified Duke index assessed by CCTA, cardiovascular risk factors, and peri-coronary inflammation in the coronary arteries of patients with coronary artery disease. Materials and Methods: One hundred seventy-two patients who underwent CCTA for typical angina were assigned into two groups based on the modified Duke index: group 1-patients with low index, ≤3 (n = 107), and group 2-patients with high index, >3 (n = 65). Demographic, clinical, and CCTA data were collected for all patients, and FAI analysis of coronary inflammation was performed. Results: Patients with increased values of the modified Duke index were significantly older compared to those with a low index (61.83 ± 9.89 vs. 64.78 ± 8.9; p = 0.002). No differences were found between the two groups in terms of gender distribution, hypertension, hypercholesterolemia, or smoking history (all p > 0.5). The 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, 20.85 ± 15.80 vs. 14.61 ± 16.66; p = 0.01 for the right coronary artery, 13.85 ± 8.04 vs. 10.91 ± 6.5; p = 0.01 for the circumflex artery, 13.26 ± 10.18 vs. 11.37 ± 8.84; p = 0.2 for the left anterior descending artery). CaRi-Heart® analysis identified a significantly higher risk of future events among patients with a high modified Duke index (34.84% ± 25.86% vs. 16.87% ± 15.80%; p < 0.0001). ROC analysis identified a cut-off value of 12.1% of the CaRi-Heart® risk score for predicting a high severity of coronary lesions, with an AUC of 0.69. Conclusions: The CT-derived modified Duke index correlates well with local perilesional inflammation as assessed using the FAI score at different levels of the coronary circulation.

Keywords: CariHeart; cardiac computed tomography; coronary stenosis; fat attenuation index; inflammation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
FAI score in the low vs. high modified Duke index patients. (A) FAI score at the level of the right coronary artery (RCA). (B) FAI score at the level of the left circumflex artery (LCX). (C) FAI score at the level of the left anterior descending artery (LAD).
Figure 2
Figure 2
CaRi-Heart® risk in the low vs. high modified Duke index patients.
Figure 3
Figure 3
CaRi-Heart® risk in the six classes of the modified Duke index patients.
Figure 4
Figure 4
ROC analysis for the accuracy of the CaRi-Heart® risk in predicting a high modified Duke index. AUC = area under the curve.
Figure 5
Figure 5
Modified Duke index in the low vs. high CaRi-Heart® risk patients.
See this image and copyright information in PMC

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