| Part Ⅰ:The relationship between coronary atherosclerotic plaque composition with CT fat attenuation index of peri-plaque adipose tissueObjective To assess the relationship between composition characteristics of atherosclerotic plaques in the coronary artery and fat attenuation index(FAI)of peri-plaque adipose tissue(PPAT)derived from coronary CT angiography(CCTA).Materials and Methods Datasets of 363 patients who underwent CCTA before being diagnosed with CAD by invasive coronary angiography(ICA)from July 2016 to November 2021 at our institution were included in this retrospective observational analysis.Meanwhile,162 age-and sexmatched individuals with no plaque(NP)diagnosed with CCTA were included in the control group.Plaque quantification and FAI analysis were based on Medis and Shukun deep learning(DL)analysis platforms,respectively,and the consistency of the FAI results measured by the above two methods was verified.Plaques were classified as non-calcified plaque(NCP)and calcified plaque(CP)groups.Plaque components were defined as six composition types:low-attenuation plaque(LAP,-30 to 75 HU),fibro-fatty(76-130 HU),fibrous(131-350 HU),low-density calcium(351700 HU),high-density calcium(701-1000 HU),and 1K(>1000 HU).These six compositional types and PPAT-FAT were evaluated for each plaque group.The NCP and CP groups performed the stratified analysis according to the median FAI value.The effect of>1K calcium burden on FAI was also analyzed in the CP group.The plotted area under the curve(AUC)of receiver operator curves was obtained.The Pearson correlation coefficient was used to assess the correlation of degrees of necrotic core plaque burden and calcium burden with PPAT-FAT.Results In total,475 NCP lesions,and 805 CP lesions were obtained,and 324 NP segments were included in the control group.The two FAI measurements show good agreement(r=0.96).The PPAT-FAI of the NCP,CP and NP groups were-69.05±7.72 HU,-78.64±8.30 HU,and-86.21±5.74 HU,respectively(p<0.001).In the stratified analysis in the NCP and CP group,according to the median FAI(-72 HU and-80HU),the necrotic core plaque burden is more significant in patients with high FAI values(34.10±18.86%vs.19.18±14.45%,p=0.024)in the NCP group.Total calcium,low-density calcium,high-density calcium,and>1K calcium burden were lower in the CP group(p<0.01).Plaques with>1K calcium burden had significantly lower PPAT-FAI values than those without>1K calcium burden(-80.78±5.68 HU vs.-72.47±10.63 HU,p<0.001),the AUC was 0.745.The Pearson’s correlation coefficient indicated a term moderately correlation both between the necrotic plaque burden and the PPAT-FAI values(r=0.683,P<0.001)in the NCP group and between the calcium plaque burden and the PPAT-FAI values(r=0.469,P<0.001)in the CP group.Conclusion1.There is a close relationship between FAI and the components of plaques,which can reflect the different degrees of inflammation around the plaques with different compositions.2.The inflammation around NCPs is more severe than that around CPs.The larger the load of the necrotic core is,the more unstable the plaque will be and the more severe the inflammation around NCPs.3.The increased calcification burden in plaques,especially the burden of highly high-density calcification,is related to the inflammation regression.The FAI value also has a specific prediction value for the presence of highly high-density calcification in CPs.4.The LAP burden was strongly positively correlated with FAI in the NCP group,and the calcified component burden was moderately negatively associated with FAI in the CP group.Part Ⅱ:The predictive value of the perivascular adipose tissue CT fat attenuation index for coronary in-stent restenosisObjectives To investigate the association between the perivascular adipose tissue(PVAT)fat attenuation index(FAI)derived from coronary computed tomography angiography(CCTA)and the prevalence of in-stent restenosis(ISR)in patients with coronary stent implantation.Materials and Methods The retrospective analysis was performed on 117 CAD patients who had undergone PCI coronary stent implantation and underwent CCTA follow-up examination in our hospital from July 2016 to November 2021.The general data of the patients and various hematological and biochemical parameters during CCTA examination were collected,including total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),triglycerides,apolipoprotein(Apo),high-sensitivity C-reactive protein(hsCRP),etc.The patients were divided into the ISR group and non-ISR group according to presence or absence of restenosis in the stent lumen.The length and diameter of the stent were measured,as well as the degree of restenosis in the ISR group.The DL analysis platform was used to analyze and measure the FAI value around the stent.All relevant variables were included in the LASSO regression to screen candidate variables,and the screened variables were included in the multivariate Logistic regression analysis to verify the correlation between the selected features and the ISR.The ROC curve was drawn to evaluate the predictive value of selected variables in the diagnosis of ISR,and the peri-stent FAI value was evaluated in three subgroups:left anterior descending coronary artery(LAD),left circumflex coronary artery(LCx)and right coronary artery(RCA).The Pearson correlation coefficient was used to evaluate the correlation between the FAI value around the stent and the degree of ISR.Results In all cases,the peri-stent FAI was significantly higher in the ISR group than in the nonISR group(-78.1±6.2 HU vs.-87.2±7.3 HU,P<0.001).After LASSO analysis,the best diagnostic model was selected,including four predictive features:peri-stent FAI,HDL-C,ApoA1,and hsCRP.The AUCs for the four characteristics of ROC curve analysis were 0.849,0.632,0.620,and 0.569,respectively.Multivariate Logistic regression analysis showed that,after adjusting for other risk factors,peri-stent FAI was an independent predictor of ISR(OR=1.403,95%CI:1.211～1.625,P<0.001).In the subgroup ROC analysis for the three coronary arteries,AUC values for the LAD,LCx,and RCA subgroups for the peristent FAI diagnostic ISR were 0.80,0.87,and 0.96,respectively.Pearson correlation coefficient showed a moderate positive correlation between the severity of restenosis and the peri-stent FAI in the ISR group(r=0.579,P<0.001).Conclusion1.Peri-stent FAI can be used as an independent non-invasive biomarker to predict the risk of ISR after stent placement.2.The severity of stent restenosis is moderately correlated with peri-stent FAI.Part Ⅲ:Predictive value of peri-coronary fat attenuation index for major adverse cardiovascular events(MACE)in patients with coronary artery diseaseObjectives To explore the predictive value of peri-coronary FAI on major adverse cardiovascular events(MACE)in patients with coronary heart disease.Materials and Methods Patients admitted to the Department of Cardiology of our hospital from November 2016 to June 2019 and diagnosed as CAD by ICA and underwent CCTA examination were selected retrospectively for the follow-up of MACE occurrence.General information about the patients,including general characteristics,clinical manifestations,risk factors,medication history,and relevant blood biochemical indicators,were collected retrospectively.The coronary segment in which the plaque was located,the nature,high-risk signs and stenosis,and calcification score(CACs)were analyzed.The FAI values of LAD,LCx,and RCA were measured and the average FAI was calculated using the DL-based method.Single-factor and multi-factor binary logistic regression analyzed the relationship between each risk factor and MACE.One-factor logistic analysis was performed first to calculate the odds ratio(OR)and 95%Confidence interval(95%CI).The risk factors with P≤0.05 were included in the multi-factor logistic regression analysis to determine the effective predictors of MACE.The ROC curve was drawn to evaluate the diagnostic ability of LAD-FAI,LCx-FAI,RCA-FAI,and mean FAI for MACE.Patients were grouped according to the cutoff value of the FAI group with the best diagnostic ability.Those higher than the cutoff value were divided into the high FAI group,and those lower than the cutoff value were divided into the low FAI group.The Kaplan-Meier survival curve was used to compare the occurrence of MACE between the two groups during the follow-up period.Results A total of 312 patients were followed up,and 216 cases were successfully followed up.Among them,193 cases(89.4%)did not develop MACE,and 23 cases(10.6%)developed MACE.The mean age of patients in the MACE-negative group was 66.2±11.6 years old,and the mean follow-up time was 44.9±6.7 months.The mean age of patients in the MACE-positive group was 63.6±7.3 years old,and the mean follow-up time was 34.7±12.8 months.In univariate Logistic regression analysis,BMI,family CAD history,LDL-C,TC,stenosis rate ≥70%,LAD-FAI,LCxFAI,RCA-FAI,and mean FAI were found to be the risk factors for MACE.In multivariate Logistic regression analysis,BMI,stenosis rate≥70%,LAD-FAI,LCx-FAI,RCA-FAI,and mean FAI were independent risk predictors of MACE after adjustment for age,CACs,and others.In comparing the predictive power of FAI,ROC analysis showed that RCA-FAI had the largest AUC(0.9098,95%CI:0.8314-0.9882)with a cutoff value of-64.5 HU.The Kaplan-Meier survival curves of the high FAI group(≥-64.5HU)and the low FAI group(<-64.5 Hu)during the follow-up period were compared,and the two groups showed significant differences(P<0.01).The high FAI group presented more adverse MACE outcomes.Conclusion1.The FAI and the mean FAI of the fat around the three coronary arteries were significantly correlated with MACE,which showed that the FAI in the MACE-positive group was considerably higher than that in the MACE-negative group.2.RCA-FAI was the best independent risk predictor of MACE of the three-vessel FAI and mean FAI,with a predicted optimal cutoff of-64.5 HU. |
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