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Stretching the limits: Assessing vascular inflammation in cardiac computed tomography

25 Aug 2023

There are many reasons to head over to the Research Gateway, but one of today’s highlights is a moderated ePoster session that aims to provide insights into the use of coronary computed tomography (CT) as a tool to assess inflammation.

Pericoronary adipose tissue attenuation, expressed as fat attenuation index (FAI) on coronary CT angiography (CCTA), is now an established method for measuring vascular inflammation.1 In today’s session, Doctor Masahiro Hoshino (Tsuchiura Kyodo General Hospital - Tsuchiura, Japan) presents an analysis of the prognostic value of preprocedural FAI in patients with non-ST elevation ACS (NSTE-ACS) treated with percutaneous coronary intervention (PCI).

This retrospective single-centre observational study included 358 patients with NSTE-ACS who underwent preprocedural 320-slice CCTA and emergent PCI within 24 hours of admission. Perivascular fat attenuation mapping was performed around the proximal (4 cm) right coronary artery (RCA), the left anterior descending artery (LAD) and the left circumflex artery (LCx).

During a median follow­-up of 1,715 days, 10.1% of patients died, and in 5.0% of all patients, death was due to cardiac causes. High FAI values around the LAD and LCx, but not around the RCA, were predictive of all-cause mortality, whereas high FAI values around each of the three vessels were predictive of cardiac mortality. FAI in culprit vessels and average FAI values across all three vessels were predictive of all-cause and cardiac mortality. Using receiver operating characteristic curve analysis, the optimal cut­-off for average FAI across the three vessels for predicting cardiac death was 65.8 (area under the curve 0.752; 95% CI 0.637–0.867) and average FAI values above this cut-off were significantly associated with cardiac mortality (p<0.001).

These findings indicate that high FAI values may be useful in guiding early targeted secondary prevention and intensive medical management in patients with NSTE-ACS after PCI. Visit Station 1 this afternoon to watch the presentation and join in the discussions about measuring vascular inflammation in various other settings including CAD and following heart transplantation.


  1. Antonopoulos AS, et al. Sci Transl Med. 2017;9:eaal2658.