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Savo MT, De Amicis M, Cozac DA, Cordoni G, Corradin S, Cozza E, Amato F, Lassandro E, Da Pozzo S, Tansella D, Di Paolantonio D, Baroni MM, Di Stefano A, De Conti G, Motta R, Pergola V. Comparative Prognostic Value of Coronary Calcium Score and Perivascular Fat Attenuation Index in Coronary Artery Disease. J Clin Med 2024; 13:5205. [PMID: 39274418 PMCID: PMC11395785 DOI: 10.3390/jcm13175205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/24/2024] [Accepted: 08/30/2024] [Indexed: 09/16/2024] Open
Abstract
Coronary artery disease (CAD) is the leading global cause of mortality, accounting for approximately 30% of all deaths. It is primarily characterized by the accumulation of atherosclerotic plaques within the coronary arteries, leading to reduced blood flow to the heart muscle. Early detection of atherosclerotic plaques is crucial to prevent major adverse cardiac events. Notably, recent studies have shown that 15% of myocardial infarctions occur in patients with non-obstructive CAD, underscoring the importance of comprehensive plaque assessment beyond merely identifying obstructive lesions. Cardiac Computed Tomography Angiography (CCTA) has emerged as a cost-effective and efficient technique for excluding obstructive CAD, particularly in patients with a low-to-intermediate clinical likelihood of the disease. Recent advancements in CCTA technology, such as improved resolution and reduced scan times, have mitigated many technical challenges, allowing for precise quantification and characterization of both calcified and non-calcified atherosclerotic plaques. This review focuses on two critical physiological aspects of atherosclerotic plaques: the burden of calcifications, assessed via the coronary artery calcium score (CACs), and perivascular fat attenuation index (pFAI), an emerging marker of vascular inflammation. The CACs, obtained through non-contrast CT scans, quantifies calcified plaque burden and is widely used to stratify cardiovascular risk, particularly in asymptomatic patients. Despite its prognostic value, the CACs does not provide information on non-calcified plaques or inflammatory status. In contrast, the pFAI, derived from CCTA, serves as an indirect marker of coronary inflammation and has shown potential in predicting adverse cardiac events. Combining both CACs and pFAI assessment could offer a comprehensive risk stratification approach, integrating the established calcification burden with novel inflammatory markers to enhance CAD prevention and management strategies.
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Affiliation(s)
- Maria Teresa Savo
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Morena De Amicis
- Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Dan Alexandru Cozac
- Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, 540136 Targu Mures, Romania
| | - Gabriele Cordoni
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Simone Corradin
- Radiology Unit, Azienda Ospedale-Università Padova, 35121 Padova, Italy
| | - Elena Cozza
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Filippo Amato
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Eleonora Lassandro
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Stefano Da Pozzo
- Radiology Unit, Azienda Ospedale-Università Padova, 35121 Padova, Italy
| | - Donatella Tansella
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Diana Di Paolantonio
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Maria Maddalena Baroni
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Antonio Di Stefano
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Giorgio De Conti
- Radiology Unit, Azienda Ospedale-Università Padova, 35121 Padova, Italy
| | - Raffaella Motta
- Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
| | - Valeria Pergola
- Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, 35121 Padova, Italy
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Chen M, Liu B, Li X, Li D, Fan L. Relationship between peri-coronary inflammation and coronary vascular function in patients with suspected coronary artery disease. Front Cardiovasc Med 2024; 11:1303529. [PMID: 38390440 PMCID: PMC10881729 DOI: 10.3389/fcvm.2024.1303529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Background In this study, we aim to investigate the relationship between the attenuation of peri-coronary adipose tissue (PCAT) in patients with suspected coronary artery disease (CAD) and the assessment of coronary vascular functions using coronary flow reserve (CFR). Methods We included 364 patients who underwent 13N-NH3 positron emission tomography/computed tomography and coronary computed tomography angiography (CCTA). We determined the relationship between fat attenuation index (FAI), PCAT volume, and other qualitative CT-derived anatomic parameters with CFR. Results We detected a decrease in CFR (<2.5) in 206 (57%) patients. At the patient level, those with reduced CFR showed a significantly higher prevalence of diffused atherosclerosis (41% vs. 23%; P < 0.001) and higher FAI (-75.5 HU vs. -77.1 HU; P = 0.014). In patients without obstructive CAD, FAI was significantly higher in those with reduced CFR (-75.5 HU vs. -77.7 HU, P = 0.026). On the vessel level, 1,092 vessels were analyzed, and 642 (59%) exhibited reduced CFR. The vessels with reduced CFR presented a significantly higher prevalence of obstructive CAD (37% vs. 26%; P < 0.001), diffused atherosclerosis (22% vs. 11%; P < 0.001), low-attenuation plaque (6% vs. 3%; P = 0.030), and positive remodeling (7% vs. 2%; P = 0.001). FAI was higher in vessels with reduced CFR (-80.8 HU vs. -81.8 HU; P = 0.045) than in normal CFR. In the patient-level analysis, obstructive CAD, diffused atherosclerosis, and FAI were independently linked with CFR. FAI was still associated with global CFR after adjusting for traditional risk factors (age, hypertension, diabetes, hyperlipidemia, and smoking). FAI remained independently associated with reduced CFR in patients without obstructive CAD. Conclusions Coronary perivascular inflammation evaluated by CCTA was independently associated with coronary vascular function. In patients without obstructive CAD, FAI was higher in the presence of reduced CFR. Altogether, FAI can help reveal microcirculatory damage in patients who do not exhibit epicardial artery stenosis.
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Affiliation(s)
- Mengyu Chen
- Department of Radiology, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
| | - Bing Liu
- Department of Radiology, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
| | - Xu Li
- Department of Radiology, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
| | - Dong Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lijuan Fan
- Department of Radiology, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, China
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