Lin Peng, Yu Feng, Jun Yuan, Yuelong Yang, Huanhua Wu, Chuanbao Deng, Hui Ma, Yuying Chen, Yang Peng
Coronary inflammation, quantified by perivascular FAI on CCTA, is significantly heightened in patients with HCM and is correlated with LV hypertrophy and dysfunction. Notably, increased LAD-FAI is independently associated with heart failure after adjustment for the included CMR parameters, suggesting its potential utility as a non-invasive imaging biomarker for risk stratification in HCM, pending external validation.
OBJECTIVE: This study aimed to evaluate coronary inflammation using the perivascular fat attenuation index (FAI) derived from coronary computed tomography angiography (CCTA) in patients with hypertrophic cardiomyopathy (HCM) and to investigate its association with heart failure (HF).
METHODS: This retrospective study included 75 patients with HCM and 75 age- and sex-matched controls without structural heart disease. Perivascular FAI was measured around the proximal right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX). All patients underwent cardiac magnetic resonance imaging for comprehensive assessment of left ventricular (LV) morphology, function, and strain parameters.
RESULTS: FAI values were significantly elevated in HCM patients compared to controls across all three vessels: LAD-FAI (-75.49 ± 9.04 vs. -83.25 ± 8.97 HU), LCX-FAI (-71.96 ± 9.62 vs. -79.48 ± 8.51 HU), and RCA-FAI (-77.57 ± 10.25 vs. -83.20 ± 8.98 HU); all p < 0.001. LAD-FAI demonstrated modest but significant correlations with markers of adverse LV remodeling, including LV mass index and global strain parameters. On multivariable logistic regression analysis, LAD-FAI was independently associated with HF (OR: 1.40; 95% CI: 1.12-1.99; p = 0.018).
CONCLUSION: Coronary inflammation, quantified by perivascular FAI on CCTA, is significantly heightened in patients with HCM and is correlated with LV hypertrophy and dysfunction. Notably, increased LAD-FAI is independently associated with heart failure after adjustment for the included CMR parameters, suggesting its potential utility as a non-invasive imaging biomarker for risk stratification in HCM, pending external validation.
ADVANCES IN KNOWLEDGE: This study provides initial evidence that perivascular FAI, a non-invasive imaging marker of coronary inflammation, is significantly elevated in patients with HCM and correlates with adverse left ventricular remodeling, impaired myocardial strain, and elevated NT-proBNP levels. Notably, increased LAD-FAI was independently associated with heart failure, suggesting a mechanistic link between regional coronary inflammation and disease severity in HCM. These findings highlight the potential utility of perivascular FAI as an imaging biomarker for heart failure risk stratification in HCM, warranting further validation in larger, prospective multicenter cohorts.