Assessment of myocardial bridging and the pericoronary fat attenuation index on coronary computed tomography angiography: predicting coronary artery disease risk

Abstract

Background The fat attenuation index (FAI) is a radiological parameter that represents pericoronary adipose tissue (PCAT) inflammation, along with myocardial bridging (MB), which leads to pathological shear stress in the coronary vessels; both are associated with coronary atherosclerosis. In the present study, we assessed the predictive value of FAI values and MB parameters through coronary computed tomography angiography (CCTA) for predicting the risk of coronary atherosclerosis and vulnerable plaque in patients with MB. Methods We included 428 patients who underwent CCTA and were diagnosed with MB. FAI values, MB parameters, and high-risk coronary plaque (HRP) characteristics were recorded. The subjects were classified into two groups (A and B) according to the absence or presence of coronary plaque in the segment proximal to the MB. Group B was further divided into Groups B1 (HRP-positive) and B2 (HRP-negative) according to the HRP characteristic classification method. The differences among the groups were analysed. Multiple logistic regression analysis was performed to determine the independent correlation between FAI values and MB parameters and coronary atherosclerosis and vulnerable plaque risk. Results Compared to the subjects in Group A, those in Group B presented greater MB lengths, MB depths and muscle index values, more severe MB systolic stenosis and higher FAIlesion values (all P < 0.05). In multivariate logistic analysis, age (OR 1.076, P < 0.001), MB systolic stenosis (OR 1.102, P < 0.001) and FAIlesion values (OR 1.502, P < 0.001) were independent risk factors for the occurrence of coronary atherosclerosis. Compared to subjects in Group B2, those in Group B1 presented greater MB lengths and higher FAI values (both P < 0.05). However, only the FAIlesion value was an independent factor for predicting HRP (OR 1.641, P < 0.001). Conclusion In patients with MB, MB systolic stenosis was associated with coronary plaque occurrence in the segment proximal to the MB. The FAI value was not only closely related to coronary atherosclerosis occurrence but also associated with plaque vulnerability. FAI values may provide more significant value in the prediction of coronary atherosclerosis than MB parameters in CCTA.

Ponte Miocárdica: Amiga, Inimiga ou Ambas?

“…While Matta et al 33 and Darabant et al 21 find the presence of MB to be associated with atherosclerotic risk reduction and even protective in a 10-year follow-up, respectively, McLaughlin et al 30 and Lu et al 31 independently showed MB-linked atherosclerosis to be mediated via complex adipogenesis and angiogenesis-mediated mechanisms. The prevalent finding of proximal to MB atherosclerosis is confirmed by numerous authors, 6,14,19,[34][35][36] confirming different long-term influences on outcomes.…”

“…Enquanto Matta et al, 33 e Darabant et al, 21 consideram a presença de PM associada à redução do risco aterosclerótico e até mesmo protetora em seguimento de 10 anos, respectivamente, McLaughlin et al, 30 e Lu et al, 31 mostraram independentemente que a aterosclerose ligada à PM é mediada por mecanismos complexos mediados por adipogênese e angiogênese. O achado prevalente de aterosclerose proximal a PM é confirmado por numerosos autores, 6 , 14 , 19 , 34 - 36 confirmando diferentes influências de longo prazo nos resultados.…”

“…As diagnostic tools have advanced substantially over the past two decades, 28 evaluation of MB-patients who presented to a cardiologist remains in the function of local logistics 17,20,[29][30][31][32] and experience in long-term management. However, before we reach the management decision, the when, the where, and the how MBs turn into a friend, enemy, or frenemy of our patients in the function of their role in atherogenesis remains the pivotal point.…”