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Quantification of perivascular inflammation does not provide incremental prognostic value over myocardial perfusion imaging and calcium scoring

2020; Springer Science+Business Media; Volume: 48; Issue: 6 Linguagem: Inglês

10.1007/s00259-020-05106-0

1619-7089

Susan Bengs, Ahmed Haider, Geoffrey Warnock, Michael Fiechter, Yves Pargaetzi, Georgios Rampidis, Dominik Etter, Winandus J. Wijnen, Angela Portmann, Elena Osto, Valérie Treyer, Dominik C. Benz, Alexander Meisel, Tobias A. Fuchs, Christoph Gräni, Ronny R. Buechel, Philipp A. Kaufmann, Aju P. Pazhenkottil, Cathérine Gebhard,

Photoacoustic and Ultrasonic Imaging

Perivascular fat attenuation index (FAI) has emerged as a novel coronary computed tomography angiography (CCTA)-based biomarker predicting cardiovascular outcomes by capturing early coronary inflammation. It is currently unknown whether FAI adds prognostic value beyond that provided by single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) and CCTA findings including coronary artery calcium scoring (CACS).A total of 492 patients (mean age 62.5 ± 10.8 years) underwent clinically indicated multimodality CCTA and electrocardiography (ECG)-gated 99mTc-tetrofosmin SPECT-MPI between May 2005 and December 2008 at our institution, and follow-up data on major adverse cardiovascular events (MACE) was obtained for 314 patients. FAI was obtained from CCTA images and was measured around the right coronary artery (FAI[RCA]), the left anterior descending artery (FAI[LAD]), and the left main coronary artery (FAI[LMCA]). During a median follow-up of 2.7 years, FAI[RCA] > - 70.1 was associated with an increased rate of MACE (log rank p = 0.049), while no such association was seen for FAI[LAD] or FAI[LMCA] (p = NS). A multivariate Cox regression model accounting for cardiovascular risk factors, CCTA and SPECT-MPI findings identified FAI[RCA] as an independent predictor of MACE (HR 2.733, 95% CI: 1.220-6.123, p = 0.015). However, FAI[RCA] was no longer a significant predictor of MACE after adding CACS (p = 0.279). A first-order interaction term consisting of sex and FAI[RCA] was significant in both models (HR 2.119, 95% CI: 1.218-3.686, p = 0.008; and HR 2.071, 95% CI: 1.111-3.861, p = 0.022).FAI does not add incremental prognostic value beyond multimodality MPI/CCTA findings including CACS. The diagnostic value of FAI[RCA] is significantly biased by sex.