High fat attenuation index (FAI) on coronary CT predicted major adverse cardiac events with AUC 0.77 and lower survival over median 2072 days in HeFH patients.
Does fat attenuation index (FAI) measured by CCTA predict major adverse cardiac events in patients with heterozygous familial hypercholesterolemia?
Fat attenuation index (FAI) derived from CCTA is a useful non-invasive imaging biomarker for predicting major adverse cardiac events in patients with heterozygous familial hypercholesterolemia.
Abstract Background Heterozygous familial hypercholesterolemia (HeFH) is a common genetic causes of premature coronary artery disease (CAD). Early identification and treatment of cardiovascular risk is an important issue. Inflammation is one of the factors that promote atherosclerosis, and fat attenuation index (FAI) measured from coronary computed tomography angiography (CCTA) enables assessment of coronary inflammation. Purpose We aimed to investigate usefulness of FAI with CCTA as a predictive value of major adverse cardiac events (MACE) in patients with HeFH. Methods We enrolled 71 consecutive patients (mean age 61 years, 65% male) with HeFH who underwent CCTA for retrospective analysis. There were 41 cases with a history of cardiovascular disease. The coronary artery calcium score, plaque score, and segment involvement score (SIS) were measured using 320-row CCTA. Kaplan-Meier analysis was used to assess the risk of major adverse cardiovascular events (MACE) stratified by FAI. Results The MACE group had significantly higher plaque scores and SIS scores (21.4 ± 10.4 vs. 8.6 ± 9.1, 8.5 ± 3.3 vs. 4.2 ± 4.4, respectively; p0.01). The FAI was significantly higher in the MACE group. Receiver-operating characteristic analysis showed that using the optimal cutoff of the FAI, MACE could be diagnosed with area under the curve of 0.77. At a median follow-up of 2072 days, there were 16 major adverse cardiac events. Kaplan–Meier analysis revealed that the survival rate worsened in patients with high FAI (log-rank test, p=0.0018). Conclusion Atherosclerotic lesions and FAI on CT in familial hypercholesterolemia might be factors defining MACE.
Mikami et al. (2025) studied this question. High fat attenuation index (FAI) on coronary CT predicted major adverse cardiac events with AUC 0.77 and lower survival over median 2072 days in HeFH patients.