Key result
High coronary perivascular FAI predicts ~33% 10-year risk of cardiac death or re-transplantation.
Why the study?
Non-invasive allograft surveillance to identify graft failure risk remains challenging, and the coronary CT angiography fat attenuation index had not been evaluated in cardiac transplant patients.
Does high baseline perivascular fat attenuation index measured by CCTA predict cardiac mortality or re-transplantation in cardiac transplant patients?
Observational (n=39)
No
Does high baseline perivascular fat attenuation index measured by CCTA predict cardiac mortality or re-transplantation in cardiac transplant patients?
Absolute Event Rate: 33% vs 0%
p-value: p=0.0022
High baseline perivascular fat attenuation index measured by CCTA may identify cardiac transplant patients at higher risk for cardiac mortality or re-transplantation.
High baseline FAI may identify higher-risk cardiac transplant recipients; leaves open prospective validation before guiding surveillance.
OBJECTIVES: In cardiac transplant recipients, non-invasive allograft surveillance for identifying patients at risk for graft failure remains challenging. The fat attenuation index (FAI) of the perivascular adipose tissue in coronary computed tomography angiography (CCTA) predicts outcomes in coronary artery disease in non-transplanted hearts; however, it has not been evaluated in cardiac transplant patients. METHODS: We followed 39 cardiac transplant patients with two or more CCTAs obtained between 2010 and 2021. We performed FAI measurements around the proximal 4 cm segments of the left anterior descending (LAD), right coronary artery (RCA), and left circumflex artery (LCx) using a previously validated methodology. The FAI was analyzed at a threshold of - 30 to - 190 Hounsfield units. RESULTS: FAI measurements were completed in 113 CCTAs, obtained on two same-vendor CT models. Within each CCTA, the FAI values between coronary vessels were strongly correlated (RCA and LAD R = 0.67 (p < 0.0001), RCA and LCx R = 0.58 (p < 0.0001), LAD and LCx R = 0.67 (p < 0.0001)). The FAIs of each coronary vessel between the patient's first and last CCTA completed at 120 kV were also correlated (RCA R = 0.73 (p < 0.0001), LAD R = 0.81 (p < 0.0001), LCx R = 0.55 (p = 0.0069). Finally, a high mean FAI value of all three coronary vessels at baseline (mean ≥ - 71 HU) was predictive of cardiac mortality or re-transplantation, however, not predictive of all cause-mortality. CONCLUSION: High baseline FAI values may identify a higher-risk cardiac transplant population; thus, FAI may support the implementation of CCTA in post-transplant surveillance. KEY POINT: • Perivascular fat attenuation measured with coronary CT is feasible in cardiac transplant patients and may predict cardiac mortality or need for re-transplantation.
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Moser et al. (2023) conducted an observational in Cardiac transplantation (n=39). High mean baseline Fat Attenuation Index (FAI ≥ -71 HU) vs. Low mean baseline FAI (< -71 HU) was evaluated on Cardiac mortality or cardiac re-transplantation (p=0.0022). High mean baseline perivascular fat attenuation index (≥ -71 HU) on coronary CT angiography predicted a higher 10-year cumulative risk of cardiac death or re-transplantation compared to lower FAI (33% vs 0%).
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