{
  "abstract": "Background: Perivascular fat attenuation index (FAI) derived from coronary computed tomography angiography (CCTA) is a novel imaging biomarker of coronary inflammation. However, its incremental value in predicting functional myocardial ischemia, defined by CT-derived fractional flow reserve (CT-FFR), beyond traditional cardiovascular risk factors and epicardial adipose tissue (EAT) volume remains unclear.\n\nMethods: A total of 380 consecutive patients who underwent clinically indicated CCTA with CT-FFR evaluation were retrospectively analyzed. Functional ischemia was defined as CT-FFR ≤0.80. Patients were stratified into low and high FAI groups based on the optimal cutoff value of −81.32 Hounsfield Units (HU). Multivariate logistic regression analysis was performed to identify independent predictors of ischemia. The incremental diagnostic performance of adding FAI to a baseline clinical model was assessed using area under the receiver operating characteristic curve (AUC), continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA).\n\nResults: Despite comparable baseline profiles for low-density lipoprotein cholesterol, body mass index, and glycemic status ( P > 0.05), patients in the high FAI group exhibited significantly lower CT-FFR values (0.75 ± 0.13 vs. 0.79 ± 0.12, P = 0.0017). After adjusting for age, gender, traditional cardiovascular risk factors, and EAT volume, average FAI remained a robust independent predictor of functional ischemia [Adjusted Odds Ratio [OR]: 1.056 per 1 HU increase; 95% Confidence Interval [CI]: 1.019–1.096; P = 0.004]. Notably, EAT volume did not reach statistical significance in the multivariate model ( P = 0.584). The addition of FAI to the clinical model resulted in a modest, non-significant improvement in AUC (0.731 vs. 0.707, P = 0.087), but yielded significant improvement in risk reclassification (continuous NRI: 0.339, P = 0.001; IDI: 0.024, P = 0.002). Subgroup analysis demonstrated a consistent risk trend across varying degrees of stenosis, age, and body mass index categories (OR range: 1.03–1.07). DCA confirmed superior net clinical benefit for the FAI-integrated model across a wide threshold probability range (25%–75%).\n\nConclusions: Coronary perivascular FAI is an independent imaging marker for CT-FFR-defined functional ischemia and provides incremental value beyond traditional risk factors and EAT volume. These findings support FAI as a non-invasive marker of coronary inflammation that may refine risk stratification for functionally significant coronary artery disease. However, as CT-FFR mainly reflects epicardial physiology, the association between FAI and microvascular dysfunction remains to be determined.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Health Management Center, The Second Hospital of Hebei Medical University , ,",
    "Department of Cardiology, The Second Hospital of Hebei Medical University , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Zhihong Gao"
    },
    {
      "affs": [
        1
      ],
      "name": "Lingmei Jia"
    },
    {
      "affs": [
        1
      ],
      "name": "Min Jia"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0bd357etg2hr2.bib",
  "cited_by": 0,
  "doi": "10.3389/fcvm.2026.1950032",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672025/?tool=EBI",
  "id": "0bd357etg2hr2",
  "issns": [
    "2297-055X"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13672025",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Cardiovascular Disease and Adiposity"
    ]
  ],
  "openalex": "W7215047713",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672025/pdf/?tool=EBI",
  "pmcid": "PMC13672025",
  "pmid": null,
  "published": "2026-10-02",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/0bd357etg2hr2.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:18Z",
      "native_id": "PMC:PMC13672025",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13672025"
    },
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "10.3389/fcvm.2026.1950032",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1950032/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiovascular Disease and Adiposity",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Perivascular fat attenuation index improves the identification of functional myocardial ischemia beyond traditional risk factors: a coronary CT angiography-derived fractional flow reserve study",
  "title_text": "Perivascular fat attenuation index improves the identification of functional myocardial ischemia beyond traditional risk factors: a coronary CT angiography-derived fractional flow reserve study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/0bd357etg2hr2",
  "venue": "Frontiers in cardiovascular medicine",
  "versions": []
}