Assessing Cardiovascular Risk by Using the Fat Attenuation Index in Coronary CT Angiography
Year: 2021
Type: article
Abstract: Coronary CT angiography (CCTA) has evolved into a first-line diagnostic test for the investigation of chest pain. Despite advances toward standardizing the reporting of CCTA through the Coronary Artery Disease Reporting and Data System (or CAD-RADS) tool, the prognostic value of CCTA in the earliest stages of atherosclerosis remains limited. Translational work on the bidirectional interplay between the coronary arteries and the perivascular adipose tissue (PVAT) has highlighted PVAT as an in vivo molecular sensor of coronary inflammation. Coronary inflammation is dynamically associated with phenotypic changes in its adjacent PVAT, which can now be detected as perivascular attenuation gradients at CCTA. These gradients are captured and quantified through the fat attenuation index (FAI), a CCTA-based biomarker of coronary inflammation. FAI carries significant prognostic value in both primary and secondary prevention (patients with and without established coronary artery disease) and offers a significant improvement in cardiac risk discrimination beyond traditional risk factors, such as coronary calcium, high-risk plaque features, or the extent of coronary atherosclerosis. Thanks to its dynamic nature, FAI may be used as a marker of disease activity, with observational studies further suggesting that it tracks the response to anti-inflammatory interventions. Finally, radiotranscriptomic studies have revealed complementary radiomic patterns of PVAT, which detect more permanent adverse fibrotic and vascular PVAT remodeling, further expanding the value of PVAT phenotyping as an important readout in modern CCTA analysis. © RSNA, 2021.
Source: Radiology Cardiothoracic Imaging
Institutions: Yale University, University of Oxford
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Developing novel biomarkers for cardiovascular risk stratification using computed tomography imaging of perivascular adipose tissue, Exploring new links between adipose tissue and vascular redox state: the role of wnt5a, 11βHSD1 inhibition: a distinctive acute-MI intervention for promotion of peri-infarct vascularisation, reduction of infarct expansion and prevention of heart failure, Using radiomics and artificial intelligence to predict cardio-embolic stroke
OpenAlex ID: W3131294792