AUTHOR=Ma Shaowei , Chen Xujiao , Ma Yue , Liu Hui , Zhang Jiayin , Xu Lei , Wang Yining , Liu Ting , Wang Kunhua , Yang Jinzhu , Hou Yang 

TITLE=Lesion-Specific Peri-Coronary Fat Attenuation Index Is Associated With Functional Myocardial Ischemia Defined by Abnormal Fractional Flow Reserve

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.755295

DOI=10.3389/fcvm.2021.755295

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> The association between abnormal invasive fractional flow reserve (FFR) and the fat attenuation index (FAI) of lesion-specific peri-coronary adipose tissue (PCAT) is unclear.</p><p><bold>Method:</bold> Data of patients who underwent coronary computed tomography angiography (CTA) and subsequent invasive coronary angiography (ICA) and FFR measurement within 1 week were retrospectively included. Lesion-specific FAI (FAI<sub>lesion</sub>), lesion-free FAI (FAI<sub>normal</sub>), epicardial adipose tissue (EAT) volume and attenuation was collected, along with stenosis severity and plaque characteristics. Lesions with FFR &lt;0.8 were considered functionally significant. The association between FFR and each parameter was analyzed by logistic regression or receiver operating characteristic curve.</p><p><bold>Result:</bold> A total of 227 patients from seven centers were included. EAT volume or attenuation, traditional risk factors, and FAI<sub>normal</sub> (with vs. without ischemia: −82 ± 11 HU vs. −81 ± 11 HU, <italic>p</italic> = 0.65) were not significantly different in patients with or without abnormal FFR. In contrast, lesions causing functional ischemia presented more severe stenosis, greater plaque volume, and higher FAI<sub>lesion</sub> (with vs. without ischemia: −71 ± 8 HU vs. −76 ± 9 HU, <italic>p</italic> &lt; 0.01). Additionally, the CTA-assessed stenosis severity (OR 1.06, 95%CI 1.04–1.08, <italic>p</italic> &lt; 0.01) and FAI<sub>lesion</sub> (OR 1.08, 95%CI 1.04–1.12, <italic>p</italic> &lt; 0.01) were determined to be independent factors that could predict ischemia. The combination model of these two CTA parameters exhibited a diagnostic value similar to the invasive coronary angiography (ICA)-assessed stenosis severity (AUC: 0.820 vs. 0.839, <italic>p</italic> = 0.39).</p><p><bold>Conclusion:</bold> It was FAI<sub>lesion</sub>, not general EAT parameters, that was independently associated with abnormal FFR and the diagnostic performance of CTA-assessed stenosis severity for functional ischemia was significantly improved in combination with FAI<sub>lesion</sub>.</p>