Perivascular fat attenuation index (FAI) on computed tomography coronary angiography reclassifies individual cardiovascular risk estimation

Abstract

Background: The perivascular fat attenuation index (FAI) detects and quantifies coronary inflammation by measuring phenotypic changes in perivascular adipose tissue by using computed tomography coronary angiography images.

Aim: The primary objective of this study was to evaluate the reclassification of cardiovascular (CV) risk after incorporating perivascular FAI assessment in currently used risk score algorithms.

Methods: This was a single-center, retrospective study of 200 patients with suspected coronary artery disease who underwent computed tomography coronary angiography in clinical practice between January 2022 and May 2022. From the patients who met the inclusion criteria, we included 50 patients with the highest CV risk according to the U-prevent calculator score to perform the perivascular FAI analysis. High perivascular FAI was defined as either a FAI-Score of ≥75th percentile in the left anterior descending artery or right coronary artery, or ≥95th percentile in the left circumflex artery.

Results: In 62 % of the patients, there was a reclassification in CV risk after perivascular FAI assessment; individual risk was upgraded in 22 % of patients and in 40 % their risk was downgraded. The presence of any plaque (72.7 % vs. 94.1 %; P = 0.032) and the proportion of patients with moderate-to-high coronary artery calcium score (≥100 Agatston units) was higher in the high perivascular FAI group compared to the low FAI group (76.5 % vs. 36.4 %; P = 0.016). Major adverse cardiac and cerebrovascular events did not differ between both groups.

Conclusion: The findings in this study suggest the potential valuable role of perivascular FAI assessment in individual CV risk prediction for patients with documented or suspected coronary artery disease.

Keywords: Computed tomography coronary angiography; Coronary artery disease; Coronary inflammation; Perivascular fat attenuation index.

Graphical abstract

Fig. 1

Flowchart demonstrating selection of the study population. The U-Prevent risk calculator predicts the 10-year CV mortality risk determined by the SCORE-2 risk chart for patients without previous CVD, for patients aged 70 and older without previous CVD the SCORE-OP-2 risk chart, for patients with previous CVD the SMART risk chart, and for patients with type 2 diabetes mellitus the ADVANCE risk chart. ADVANCE denotes Action in Diabetes and Vascular disease: pretax and diamicron-MR controlled evaluation, CAD-RADS Coronary Artery Disease-Reporting and Data System, CTCA computed tomography coronary angiography, CV cardiovascular, SCORE(-OP-)2 Systematic Coronary Risk Evaluation Older Persons-2, SMART Secondary Manifestations of Arterial disease.

Fig. 2

All computed tomography coronary angiography images and clinical risk factors are uploaded to the automated cloud-based medical device. The device performs automated segmentation of heart structures, identifies the perivascular adipose tissue, and calculates the perivascular FAI around each coronary vessel adjusted for technical and anatomical parameters, along with patient demographics. It also integrates a cardiac risk stratification tool for clinical decision making, the CaRi-Heart®. CAD denotes coronary artery disease, CT computed tomography, FAI fat attenuation index, RCA right coronary artery.

Fig. 3

N = number of patients. Sankey diagram demonstrates cardiovascular (CV) risk reclassification of the risk models with (left) and without (right) addition of FAI. The proportion of patients without change (gray), reclassification to higher CV risk group (red), and reclassification to lower CV risk group (green) are shown. The U-Prevent risk calculator predicts the 10-year CV mortality risk determined by the SCORE-2 risk chart for patients without previous CVD, for patients aged 70 and older without previous CVD the SCORE-OP-2 risk chart, for patients with previous CVD the SMART risk chart, and for patients with type 2 diabetes mellitus the ADVANCE risk chart. FAI denotes fat attenuation index.

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