Transmural ECV gradient (OR 1.12; 95% CI 1.01-1.25), myocardial bridging, and high FAI-RCA independently predicted vasospastic angina in patients with non-obstructive coronary arteries.
Observational (n=100)
Does a multi-parametric CCTA approach including transmural ECV gradient, FAI-RCA, and myocardial bridging identify vasospastic angina in patients with ANOCA?
A multi-parametric CCTA approach integrating transmural ECV gradient, FAI-RCA, and myocardial bridging provides significant diagnostic value for identifying vasospastic angina in patients with ANOCA.
Odds Ratio: 1.12 (95% CI 1.01–1.25)
p-value: p=< 0.05
BACKGROUND: Coronary CT angiography (CCTA) has evolved beyond anatomical assessment to include sophisticated tissue characterization. While an elevated perivascular fat attenuation index around the right coronary artery (FAI-RCA) is known to reflect coronary inflammation in vasospastic angina (VSA), recurrent vasospasms may also induce chronic subclinical myocardial injury and subsequent remodeling, potentially associated with an increased myocardial extracellular volume fraction (ECV). However, the diagnostic integration of ECV and FAI-RCA for identifying VSA in patients with angina with non-obstructive coronary arteries (ANOCA) remains to be elucidated. METHODS AND RESULTS: This study included consecutive ANOCA patients underwent CCTA with a dedicated ECV protocol, followed by an invasive spasm provocation test. Comprehensive CCTA analysis quantified both FAI-RCA and the transmural ECV gradient (the difference between endocardial and epicardial ECV: ECVEndo-ECVEpi). Of the 100 patients analyzed (mean age:65.3 ± 11.8 years; 55% male), 27 were diagnosed with VSA. Multivariable logistic regression analysis identified transmural ECV gradient OR:1.12(95% CI:1.01-1.25), presence of myocardial bridging (MB) OR:3.49(1.25-9.74), and high FAI-RCA (>-70.95HU) OR:5.79(2.06-16.30) as significant independent predictors of VSA (all P < 0.05). Notably, the integration of transmural ECV gradient provided incremental diagnostic value beyond FAI-RCA and MB assessed by net reclassification improvement and integrated discrimination improvement. CONCLUSIONS: A multi-parametric CCTA approach potentially identifies patients at high risk for VSA. The significant association of transmural ECV gradient with VSA suggests that myocardial remodeling imaging provides a novel diagnostic window into the cumulative myocardial impact of vasospasm, independent of active adipose tissue inflammation and the presence of MB.
Sayama et al. (Sun,) conducted a observational in Angina with non-obstructive coronary arteries (ANOCA) (n=100). Transmural ECV gradient, myocardial bridging, and high FAI-RCA was evaluated on Diagnosis of vasospastic angina (VSA) (OR 1.12, 95% CI 1.01-1.25, p=< 0.05). Transmural ECV gradient (OR 1.12; 95% CI 1.01-1.25), myocardial bridging, and high FAI-RCA independently predicted vasospastic angina in patients with non-obstructive coronary arteries.