The fat attenuation index (FAI) derived from coronary CT angiography serves as a biomarker of coronary inflammation, improving cardiac risk discrimination beyond traditional risk factors.
Does the fat attenuation index (FAI) derived from CCTA improve cardiovascular risk discrimination beyond traditional risk factors in patients undergoing investigation for chest pain?
The fat attenuation index (FAI) derived from CCTA is a promising imaging biomarker of coronary inflammation that improves cardiovascular risk discrimination beyond traditional risk factors.
Coronary CT angiography (CCTA) has evolved into a first-line diagnostic test for the investigation of chest pain. Despite advances toward standardizing the reporting of CCTA through the Coronary Artery Disease Reporting and Data System (or CAD-RADS) tool, the prognostic value of CCTA in the earliest stages of atherosclerosis remains limited. Translational work on the bidirectional interplay between the coronary arteries and the perivascular adipose tissue (PVAT) has highlighted PVAT as an in vivo molecular sensor of coronary inflammation. Coronary inflammation is dynamically associated with phenotypic changes in its adjacent PVAT, which can now be detected as perivascular attenuation gradients at CCTA. These gradients are captured and quantified through the fat attenuation index (FAI), a CCTA-based biomarker of coronary inflammation. FAI carries significant prognostic value in both primary and secondary prevention (patients with and without established coronary artery disease) and offers a significant improvement in cardiac risk discrimination beyond traditional risk factors, such as coronary calcium, high-risk plaque features, or the extent of coronary atherosclerosis. Thanks to its dynamic nature, FAI may be used as a marker of disease activity, with observational studies further suggesting that it tracks the response to anti-inflammatory interventions. Finally, radiotranscriptomic studies have revealed complementary radiomic patterns of PVAT, which detect more permanent adverse fibrotic and vascular PVAT remodeling, further expanding the value of PVAT phenotyping as an important readout in modern CCTA analysis. © RSNA, 2021.
Klüner et al. (Mon,) conducted a review in Cardiovascular risk. Fat Attenuation Index (FAI) was evaluated. The fat attenuation index (FAI) derived from coronary CT angiography serves as a biomarker of coronary inflammation, improving cardiac risk discrimination beyond traditional risk factors.