Key result
Mean right coronary artery perivascular fat attenuation index values in patients with suspected infarct-like myocarditis were similar to healthy volunteers (-92.8 vs -95.2 HU, p=0.8).
Why the study?
The pathophysiology of angina-like symptoms in myocarditis remains unclear, motivating exploration of coronary inflammation using perivascular fat attenuation index by CCTA in clinically suspected myocarditis with infarct-like presentation.
Does right coronary artery perivascular fat attenuation index (pFAI) differ between patients with clinically suspected infarct-like myocarditis and healthy volunteers?
Observational (n=15)
Does right coronary artery perivascular fat attenuation index (pFAI) differ between patients with clinically suspected infarct-like myocarditis and healthy volunteers?
Absolute Event Rate: -92.8% vs -95.2%
p-value: p=0.8
In patients with infarct-like myocarditis, RCA pFAI values are similar to healthy volunteers but correlate with worse biventricular volumes and right ventricular ejection fraction.
Similar RCA pFAI values caution against diagnostic use in suspected myocarditis; challenges its role as an inflammatory marker and leaves open validation in larger trials.
Background: The pathophysiology of angina-like symptoms in myocarditis is still unclear. Perivascular fat attenuation index (pFAI) by coronary computed tomography angiography (CCTA) is a non-invasive marker of coronary inflammation (CI) in atherosclerosis. We explored the presence of CI in clinically suspected myocarditis with infarct-like presentation. Methods: We retrospectively included 15 consecutive patients (67% male, age 30 ± 10 years) with clinically suspected infarct-like myocarditis who underwent CCTA to rule out coronary artery disease. Right coronary artery (RCA) pFAI mean value was compared with that of healthy volunteers. Results: Mean RCA pFAI value was −92.8 ± 8.4 HU, similar to that of healthy volunteers (−95.2 ± 6.0, p = 0.8). We found no correlation between RCA pFAI mean values and peak Troponin I (r = −0.43, p = 0.11) and C-reactive protein at diagnosis (r = −0.25, p = 0.42). Patients with higher pFAI values showed higher biventricular end-systolic volumes (ESV) (p = 0.038 for left and p = 0.024 for right ventricle) and lower right ventricular ejection fraction (RVEF) (p = 0.038) on cardiovascular magnetic resonance. Conclusions: In clinically suspected myocarditis with infarct-like presentation, RCA pFAI values are lower than those validated in atherosclerosis. The correlation between higher pFAI values, higher biventricular ESV and lower RVEF, may suggest a role of pFAI in predicting non-atherosclerotic CI (i.e., infective/immune-mediated “endothelialitis”).
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Baritussio et al. (2021) conducted an observational in Clinically suspected myocarditis with infarct-like presentation (n=15). Right coronary artery (RCA) perivascular fat attenuation index (pFAI) vs. Healthy volunteers was evaluated on Right coronary artery (RCA) pFAI mean value (p=0.8). Mean right coronary artery perivascular fat attenuation index values in patients with suspected infarct-like myocarditis were similar to healthy volunteers (-92.8 vs -95.2 HU, p=0.8).
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