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Quantification of Coronary Inflammation Using Fat Attenuation Index (FAI) in Indians: A Retrospective Study

Received: 9 June 2021    Accepted: 23 June 2021    Published: 30 June 2021
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Abstract

Background: Asian Indians have the highest prevalence (11%) of coronary artery risk worldwide compared to all other races. So far no quantifiable risk factor has been shown to explain such a high prevalence. Fat attenuation index (FAI) using CT coronary angiography (CTCA) has been recently used to demonstrate coronary perivascular inflammation and to confirm that atherosclerosis is an inflammatory process. Hence this study was conducted to determine FAI using CTCA in 200 adult Indians as a retrospective study to determine if it can be the answer to establish the cause for high prevalence of CAD in Indians and whether there are differences in FAI in normal adults and those with significant CAD and to determine if it could be used as imaging biomarker for diagnosis and follow up of such patients. Material and Methods: Retrospective study of 200 patients who underwent CTCA was done. Patients were divided into two groups based on no coronary disease (NOCAD) and those with significant coronary artery disease (CAD). Patient demographics were recorded for both groups. FAI estimation was done along with Plaque volume index (PVI), pericardial volume estimation and the differences between the two groups were statistically analysed. Results: Mean patient age in both groups was 52 years with male predominance (75-80%). Mean FAI,s for left anterior descending and right coronary arteries was 45.4 and -44.7 HU and of -38.0 and -39.2 HU for NOCAD and CAD groups respectively (p<0.001). Sensitivity and specificity of FAI to differentiate NOCAD from CAD at a cut off value >-38HU was 73% and 80% respectively with LR of 3.6. Conclusion: Normal adult Indians with NOCAD showed a high FAI compared to all other races which could be reason for highest prevalence of CAD amongst Indians. FAI can be used as imaging biomarker to differentiate CAD from NOCAD with sensitivity and specificity of 73% and 80% respectively.

Published in Cardiology and Cardiovascular Research (Volume 5, Issue 3)
DOI 10.11648/j.ccr.20210503.11
Page(s) 129-134
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Coronary Artery Disease, CT Coronary Angiography, Fat Attenuation Index

References
[1] Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med. 1999; 340: 115–126.
[2] Mohan V, Deepa R, Rani SS, et al. Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: The Chennai Urban Population Study (CUPS No. 5). J Am CollCardiol 2001; 38: 682-7. 10.1016/S0735-1097(01)01415-2.
[3] Enas EA, Senthilkumar A. Coronary artery disease in Asian Indians: an update and review. Internet J Cardiol 2001; 1.
[4] Sharma M, Ganguly NK. Premature coronary artery disease in Indians and its associated risk factors. Vasc Health Risk Manag 2005; 1: 217-25.
[5] Douglas PS, Hoffmann U, Patel MR. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015; 372: 1291–1300.
[6] SCOT-HEART investigators CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. Lancet. 2015; 385: 2383–2391.
[7] Antonopoulos AS, Sanna F, Sabharwal N. Detecting human coronary inflammation by imaging perivascular fat. SciTransl Med. 2017; 9: eaal2658.
[8] T. Sugiyama, Y. Kanaji, M. Hoshino, M. Yamaguchi, M. Hada, T. Misawa, Y. Sumino, K. Nogami, H. Ueno, T. Kakuta. Prognostic value of fat attenuation index of pericoronary adipose tissue surrounding left anterior descending artery on coronary computed tomography angiography. European Heart Journal, Volume 41, Issue Supplement_2, November 2020, ehaa 946.1 346.
[9] Ma R, Ties D, Assen MV, Pelgrim GJ, Sidorenkov G, van Ooijen PM etal. Towards reference values of pericoronary adipose tissue attenuation: impact of coronary artery and tube voltage in coronary computed tomography angiography. European Radiology (2020) 30: 6838–6846.
[10] Oikonomou E. K., Marwan M., Desai M. Y. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. Lancet (London, England) 2018; 392: 929–939.
[11] Baker AR, Silva NF, Quinn DW, Harte AL, Pagano D, Bonser RS, et al. Human epicardial adipose tissue expressesa pathogenic profile of adipocytokines in patients withcardiovascular disease. Cardiovasc Diabetol 2006; 5: 1.
[12] Sacks HS, Fain JN, Cheema P, Bahouth SW, Garrett E, Wolf RY, et al. Inflammatory genes in epicardial fat contiguouswith coronary atherosclerosis in the metabolic syndromeand type 2 diabetes: Changes associated with pioglitazone. Diabetes Care 2011; 34: 730-3.
[13] Lacobellis G, Bianco AC. Epicardial adipose tissue: Emergingphysiological, pathophysiological and clinical features. Trends Endocrinol Metab 2011; 22: 450-7.
[14] Mazurek T, Zhang L, Zalewski A, Mannion JD, Diehl JT, Arafat H, et al. Human epicardial adipose tissue is a sourceof inflammatory mediators. Circulation 2003; 108: 2460-6.
[15] Hirata Y, Tabata M, Kurobe H, Motoki T, Akaike M, Nishio C, et al. Coronary atherosclerosis is associated with macrophagepolarization in epicardial adipose tissue. J Am Coll Cardiol 2011; 58: 248-55.
[16] Xu H, Barnes GT, Yang Q, Tan G, Yang D, Chou CJ, et al. Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance. J ClinInvest 2003; 112: 1821-30.
[17] Weisberg SP, McCann D, Desai M, Rosenbaum M, Leibel RL, Ferrante AW Jr. Obesity is associated withmacrophage accumulation in adipose tissue. J ClinInvest 2003; 112: 1796-808.
[18] Yu M, Dai X, Deng J, Lu Z, Shen C, Zhang J. Diagnostic performance of perivascular fat attenuation index to predict hemodynamic significance of coronary stenosis: a preliminary coronary computed tomography angiography study. Eur Radiol. 2020 Feb; 30 (2): 673-681.
[19] Kluner LV, Oikonomu EK, Phil D, Antoniade C. Assessing Cardiovascular Risk by Using the Fat Attenuation Index in Coronary CT Angiography. Radiology: Cardiothoracic Imaging 2021; 3 (1): e200563 • https://doi.org/10.1148/ryct.2021200563.
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  • APA Style

    Atul Kapoor, Aprajita Kapoor, Goldaa Mahajan. (2021). Quantification of Coronary Inflammation Using Fat Attenuation Index (FAI) in Indians: A Retrospective Study. Cardiology and Cardiovascular Research, 5(3), 129-134. https://doi.org/10.11648/j.ccr.20210503.11

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    ACS Style

    Atul Kapoor; Aprajita Kapoor; Goldaa Mahajan. Quantification of Coronary Inflammation Using Fat Attenuation Index (FAI) in Indians: A Retrospective Study. Cardiol. Cardiovasc. Res. 2021, 5(3), 129-134. doi: 10.11648/j.ccr.20210503.11

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    AMA Style

    Atul Kapoor, Aprajita Kapoor, Goldaa Mahajan. Quantification of Coronary Inflammation Using Fat Attenuation Index (FAI) in Indians: A Retrospective Study. Cardiol Cardiovasc Res. 2021;5(3):129-134. doi: 10.11648/j.ccr.20210503.11

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  • @article{10.11648/j.ccr.20210503.11,
      author = {Atul Kapoor and Aprajita Kapoor and Goldaa Mahajan},
      title = {Quantification of Coronary Inflammation Using Fat Attenuation Index (FAI) in Indians: A Retrospective Study},
      journal = {Cardiology and Cardiovascular Research},
      volume = {5},
      number = {3},
      pages = {129-134},
      doi = {10.11648/j.ccr.20210503.11},
      url = {https://doi.org/10.11648/j.ccr.20210503.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20210503.11},
      abstract = {Background: Asian Indians have the highest prevalence (11%) of coronary artery risk worldwide compared to all other races. So far no quantifiable risk factor has been shown to explain such a high prevalence. Fat attenuation index (FAI) using CT coronary angiography (CTCA) has been recently used to demonstrate coronary perivascular inflammation and to confirm that atherosclerosis is an inflammatory process. Hence this study was conducted to determine FAI using CTCA in 200 adult Indians as a retrospective study to determine if it can be the answer to establish the cause for high prevalence of CAD in Indians and whether there are differences in FAI in normal adults and those with significant CAD and to determine if it could be used as imaging biomarker for diagnosis and follow up of such patients. Material and Methods: Retrospective study of 200 patients who underwent CTCA was done. Patients were divided into two groups based on no coronary disease (NOCAD) and those with significant coronary artery disease (CAD). Patient demographics were recorded for both groups. FAI estimation was done along with Plaque volume index (PVI), pericardial volume estimation and the differences between the two groups were statistically analysed. Results: Mean patient age in both groups was 52 years with male predominance (75-80%). Mean FAI,s for left anterior descending and right coronary arteries was 45.4 and -44.7 HU and of -38.0 and -39.2 HU for NOCAD and CAD groups respectively (p-38HU was 73% and 80% respectively with LR of 3.6. Conclusion: Normal adult Indians with NOCAD showed a high FAI compared to all other races which could be reason for highest prevalence of CAD amongst Indians. FAI can be used as imaging biomarker to differentiate CAD from NOCAD with sensitivity and specificity of 73% and 80% respectively.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Quantification of Coronary Inflammation Using Fat Attenuation Index (FAI) in Indians: A Retrospective Study
    AU  - Atul Kapoor
    AU  - Aprajita Kapoor
    AU  - Goldaa Mahajan
    Y1  - 2021/06/30
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ccr.20210503.11
    DO  - 10.11648/j.ccr.20210503.11
    T2  - Cardiology and Cardiovascular Research
    JF  - Cardiology and Cardiovascular Research
    JO  - Cardiology and Cardiovascular Research
    SP  - 129
    EP  - 134
    PB  - Science Publishing Group
    SN  - 2578-8914
    UR  - https://doi.org/10.11648/j.ccr.20210503.11
    AB  - Background: Asian Indians have the highest prevalence (11%) of coronary artery risk worldwide compared to all other races. So far no quantifiable risk factor has been shown to explain such a high prevalence. Fat attenuation index (FAI) using CT coronary angiography (CTCA) has been recently used to demonstrate coronary perivascular inflammation and to confirm that atherosclerosis is an inflammatory process. Hence this study was conducted to determine FAI using CTCA in 200 adult Indians as a retrospective study to determine if it can be the answer to establish the cause for high prevalence of CAD in Indians and whether there are differences in FAI in normal adults and those with significant CAD and to determine if it could be used as imaging biomarker for diagnosis and follow up of such patients. Material and Methods: Retrospective study of 200 patients who underwent CTCA was done. Patients were divided into two groups based on no coronary disease (NOCAD) and those with significant coronary artery disease (CAD). Patient demographics were recorded for both groups. FAI estimation was done along with Plaque volume index (PVI), pericardial volume estimation and the differences between the two groups were statistically analysed. Results: Mean patient age in both groups was 52 years with male predominance (75-80%). Mean FAI,s for left anterior descending and right coronary arteries was 45.4 and -44.7 HU and of -38.0 and -39.2 HU for NOCAD and CAD groups respectively (p-38HU was 73% and 80% respectively with LR of 3.6. Conclusion: Normal adult Indians with NOCAD showed a high FAI compared to all other races which could be reason for highest prevalence of CAD amongst Indians. FAI can be used as imaging biomarker to differentiate CAD from NOCAD with sensitivity and specificity of 73% and 80% respectively.
    VL  - 5
    IS  - 3
    ER  - 

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Author Information
  • Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India

  • Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India

  • Advanced Diagnostics and Institute of Imaging, Amritsar, Punjab, India

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