Association of coronary inflammation with plaque vulnerability and fractional flow reserve in coronary artery disease

You-Jung Choi; Seokhun Yang; Henry West; Pete Tomlins; Masahiro Hoshino; Tadashi Murai; Doyeon Hwang; Eun-Seok Shin; Joon-Hyung Doh; Chang-Wook Nam; Jianan Wang; Hitoshi Matsuo; Tsunekazu Kakuta; Charalambos Antoniades; Bon-Kwon Koo

doi:10.1016/j.jcct.2024.10.013

Association of coronary inflammation with plaque vulnerability and fractional flow reserve in coronary artery disease

J Cardiovasc Comput Tomogr. 2024 Nov 1:S1934-5925(24)00463-5. doi: 10.1016/j.jcct.2024.10.013. Online ahead of print.

Authors

Affiliations

¹ Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
² Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
³ Acute Multidisciplinary Imaging and Interventional Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Sydney Medical School, University of Sydney, Sydney, Australia; Caristo Diagnostics LTD, Oxford, United Kingdom.
⁴ Acute Multidisciplinary Imaging and Interventional Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
⁵ Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
⁶ Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea; Korea and Division of Cardiology, Ulsan Hospital, Ulsan, South Korea.
⁷ Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea.
⁸ Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea.
⁹ Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
¹⁰ Department of Cardiology, Gifu Heart Center, Gifu, Japan.
¹¹ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea; Institute on Aging, Seoul National University, Seoul, South Korea. Electronic address: bkkoo@snu.ac.kr.

PMID: 39488477
DOI: 10.1016/j.jcct.2024.10.013

Abstract

Background: The fat attenuation index (FAI) measured using coronary computed tomography angiography (CCTA) enables the direct evaluation of pericoronary adipose tissue composition and vascular inflammation. We aimed to investigate the association of fractional flow reserve (FFR) and plaque vulnerability with coronary inflammation.

Methods: Patients with suspected coronary artery disease (CAD) who underwent CCTA and invasive FFR measurements within 90-day were included. A cloud-based medical device, CaRi-Heart, serves as a surrogate tool for evaluating coronary inflammation based on FAI by analyzing CCTA images. The correlations between CCTA-defined plaque characteristics, invasive coronary angiographic and physiologic assessments, and CaRi-Heart risk were analyzed. The primary endpoint was the patient-oriented composite outcome (POCO) consisting of all-cause death, any myocardial infarction, and any revascularization.

Results: A total of 564 patients (median age 67.0 years; 75.4 % men) were included. There were no significant differences in quantitative and qualitative plaque characteristics or FFR between the high- and low-CaRi-Heart risk groups (i.e., ≥5 % and <5 %). During the median follow-up of 3.2 years [1.13-4.73 years], CaRi-Heart risk ≥5 % was associated with a significantly higher rate of POCO compared to CaRi-Heart risk <5 % (0.9 % vs. 10.1 %, P = 0.037). The CaRi-Heart risk was an independent predictor of POCO as a continuous (adjusted HR 1.016, 95 % CI 1.005-0.027, P = 0.004) and categorical variable (CaRi-Heart risk ≥5 %, adjusted HR 2.949, 95 % CI 1.182-7.360, P = 0.021), regardless of high-risk plaque characteristics and FFR.

Conclusion: Coronary inflammation risk assessed using CaRi-Heart risk provides independent prognostic information regardless of plaque vulnerability and physiologic stenosis in patients with CAD.

Keywords: Coronary artery disease; Coronary computed coronary angiography; Coronary plaque; Fat attenuation index; Physiologic stenosis.