The Perivascular Fat Attenuation Index Improves the Diagnostic Performance for Functional Coronary Stenosis
<b>Background:</b> Coronary computed tomography angiography (CCTA) is an established first-line test in the investigation of patients with suspected coronary artery disease (CAD), while the perivascular fat attenuation index (FAI) derived from CT seems to be a feasible and efficient tool...
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| Format: | Article |
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MDPI AG
2022-04-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/9/5/128 |
| _version_ | 1797498952824651776 |
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| author | Hankun Yan Na Zhao Wenlei Geng Zhihui Hou Yang Gao Bin Lu |
| author_facet | Hankun Yan Na Zhao Wenlei Geng Zhihui Hou Yang Gao Bin Lu |
| author_sort | Hankun Yan |
| collection | DOAJ |
| description | <b>Background:</b> Coronary computed tomography angiography (CCTA) is an established first-line test in the investigation of patients with suspected coronary artery disease (CAD), while the perivascular fat attenuation index (FAI) derived from CT seems to be a feasible and efficient tool for the identification of ischemia. The association between the FAI and lesion-specific ischemia as assessed by fractional flow reserve (FFR) remains unclear. <b>Methods:</b> In a total of 261 patients, 294 vessels were assessed for CCTA stenosis, vessel-specific FAI, lesion-specific FAI, and plaque characteristics. The diagnostic accuracies of each parameter and the combined approach were analyzed via the receiver operating characteristic curve (ROC) with FFR as the reference standard. The determinants of FAI were statistically analyzed. <b>Results:</b> The cutoff values of vessel-specific FAI and lesion-specific FAI scores calculated according to the Youden index were −70.97 and −73.95 HU, respectively. No significant differences were noted between them; however, they exhibited a strong correlation. No significant differences were noted between the area under the curve (AUC) scores of vessel-specific FAI (0.677), lesion-specific FAI (0.665), and CCTA (0.607) (<i>p</i> > 0.05 for all) results. The addition of two FAI measures to the CCTA showed improvements in the discrimination (AUC) and reclassification ability (relative integrated discrimination improvement (IDI) and category-free net reclassification index (NRI)), vessel-specific FAI (AUC, 0.696; NRI, 49.6%; IDI, 5.9%), and lesion-specific FAI scores (AUC, 0.676; NRI, 43.3%; IDI, 5.4%); (<i>p</i> < 0.01 for all). Multivariate analysis revealed that low-attenuation plaque (LAP) volume was an independent predictor of two FAI measures. <b>Conclusion:</b> The combined approach of adding vessel-specific FAI or lesion-specific FAI scores could improve the identification of ischemia compared with CCTA alone. The LAP volume was the independent risk factor for both tools. |
| first_indexed | 2024-03-10T03:41:39Z |
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| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-10T03:41:39Z |
| publishDate | 2022-04-01 |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-94c9002b2f5e4586bf940c6a3b1d03ee2023-11-23T11:32:31ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252022-04-019512810.3390/jcdd9050128The Perivascular Fat Attenuation Index Improves the Diagnostic Performance for Functional Coronary StenosisHankun Yan0Na Zhao1Wenlei Geng2Zhihui Hou3Yang Gao4Bin Lu5Department of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, ChinaDepartment of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, ChinaDepartment of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, ChinaDepartment of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, ChinaDepartment of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, ChinaDepartment of Radiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China<b>Background:</b> Coronary computed tomography angiography (CCTA) is an established first-line test in the investigation of patients with suspected coronary artery disease (CAD), while the perivascular fat attenuation index (FAI) derived from CT seems to be a feasible and efficient tool for the identification of ischemia. The association between the FAI and lesion-specific ischemia as assessed by fractional flow reserve (FFR) remains unclear. <b>Methods:</b> In a total of 261 patients, 294 vessels were assessed for CCTA stenosis, vessel-specific FAI, lesion-specific FAI, and plaque characteristics. The diagnostic accuracies of each parameter and the combined approach were analyzed via the receiver operating characteristic curve (ROC) with FFR as the reference standard. The determinants of FAI were statistically analyzed. <b>Results:</b> The cutoff values of vessel-specific FAI and lesion-specific FAI scores calculated according to the Youden index were −70.97 and −73.95 HU, respectively. No significant differences were noted between them; however, they exhibited a strong correlation. No significant differences were noted between the area under the curve (AUC) scores of vessel-specific FAI (0.677), lesion-specific FAI (0.665), and CCTA (0.607) (<i>p</i> > 0.05 for all) results. The addition of two FAI measures to the CCTA showed improvements in the discrimination (AUC) and reclassification ability (relative integrated discrimination improvement (IDI) and category-free net reclassification index (NRI)), vessel-specific FAI (AUC, 0.696; NRI, 49.6%; IDI, 5.9%), and lesion-specific FAI scores (AUC, 0.676; NRI, 43.3%; IDI, 5.4%); (<i>p</i> < 0.01 for all). Multivariate analysis revealed that low-attenuation plaque (LAP) volume was an independent predictor of two FAI measures. <b>Conclusion:</b> The combined approach of adding vessel-specific FAI or lesion-specific FAI scores could improve the identification of ischemia compared with CCTA alone. The LAP volume was the independent risk factor for both tools.https://www.mdpi.com/2308-3425/9/5/128coronary artery diseasecoronary computed tomography angiographyischemiafat attenuation index |
| spellingShingle | Hankun Yan Na Zhao Wenlei Geng Zhihui Hou Yang Gao Bin Lu The Perivascular Fat Attenuation Index Improves the Diagnostic Performance for Functional Coronary Stenosis Journal of Cardiovascular Development and Disease coronary artery disease coronary computed tomography angiography ischemia fat attenuation index |
| title | The Perivascular Fat Attenuation Index Improves the Diagnostic Performance for Functional Coronary Stenosis |
| title_full | The Perivascular Fat Attenuation Index Improves the Diagnostic Performance for Functional Coronary Stenosis |
| title_fullStr | The Perivascular Fat Attenuation Index Improves the Diagnostic Performance for Functional Coronary Stenosis |
| title_full_unstemmed | The Perivascular Fat Attenuation Index Improves the Diagnostic Performance for Functional Coronary Stenosis |
| title_short | The Perivascular Fat Attenuation Index Improves the Diagnostic Performance for Functional Coronary Stenosis |
| title_sort | perivascular fat attenuation index improves the diagnostic performance for functional coronary stenosis |
| topic | coronary artery disease coronary computed tomography angiography ischemia fat attenuation index |
| url | https://www.mdpi.com/2308-3425/9/5/128 |
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