Perivascular fat attenuation index improves the identification of functional myocardial ischemia beyond traditional risk factors: a coronary CT angiography-derived fractional flow reserve study
- 1Department of Health Management Center, The Second Hospital of Hebei Medical University , ,
- 2Department of Cardiology, The Second Hospital of Hebei Medical University , ,
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.
Methods: 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).
Results: 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%).
Conclusions: 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.
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BibTeX
@article{gao2026perivascular,
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}},
author = {Zhihong Gao and Lingmei Jia and Min Jia},
journal = {Frontiers in cardiovascular medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1950032},
url = {https://europepmc.org/article/PMC/PMC13672025},
note = {CC BY},
}
RIS
TY - JOUR
TI - Perivascular fat attenuation index improves the identification of functional myocardial ischemia beyond traditional risk factors: a coronary CT angiography-derived fractional flow reserve study
AU - Zhihong Gao
AU - Lingmei Jia
AU - Min Jia
PY - 2026
DA - 2026/10/02
JO - Frontiers in cardiovascular medicine
DO - 10.3389/fcvm.2026.1950032
UR - https://europepmc.org/article/PMC/PMC13672025
AB - 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. Methods: 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). Results: 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%). Conclusions: 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.
SN - 2297-055X
ER -