The Predictive Value of Lesion-Specific Fat Attenuation Index for Major Adverse Cardiovascular Events in Patients with Type 2 Diabetes

Author:

Liu Meiju1,Zhen Yanhua1,Shang Jin1,Dang Yuxue1,Zhang Qian1,Ni Weishi1,Qiao Yujuan1,Hou Yang1

Affiliation:

1. Shengjing Hospital of China Medical University

Abstract

Abstract Background The purpose of this study was to explore the prognostic significance of the lesion-specific Fat Attenuation Index (FAI) in forecasting major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM). Methods This study conducted a retrospective analysis of 304 patients diagnosed with T2DM who underwent coronary computed tomography angiography (CCTA) in our hospital from December 2011 to October 2021. All participants were followed for a period exceeding three years. Detailed clinical data and CCTA imaging features were carefully recorded, encompassing lesion-specific FAI, FAI of the right coronary artery, features of high-risk plaques, and the coronary artery calcium score (CACS). The spectrum of MACE included in the study comprised cardiac death, acute coronary syndrome (which encompasses unstable angina pectoris and myocardial infarction), late-phase coronary revascularization procedures, and hospital admissions prompted by heart failure. Results Within the three-year follow-up, 76 patients with T2DM suffered from MACE. The lesion-specific FAI in patients who experienced MACE was notably higher compared to those without MACE (-84.87 ± 11.36 Hounsfield Units (HU) vs. -88.65 ± 11.89 HU, P = 0.016). Multivariate Cox regression analysis revealed that CACS of 100 or greater (hazard ratio [HR] = 3.766, 95% confidence interval [CI]: 2.045–6.938, P < 0.001) and lesion-specific FAI higher than − 83.5 HU (HR = 2.172, 95% CI: 1.336–3.532, P = 0.002) were independently associated with heightened risk of MACE in T2DM patients over a three-year period. Subgroup analysis indicated that a lesion-specific FAI higher than − 83.5 HU (HR = 2.017, 95% CI: 1.143–3.559, P = 0.015) independently correlated with MACE in T2DM patients exhibiting severe coronary calcification. Moreover, the combination of CACS ≥ 100 and lesion-specific FAI>-83.5 HU significantly enhanced the predictive value of MACE in T2DM patients within 3 years. Conclusions The elevated lesion-specific FAI emerged as an independent prognostic factor for MACE in individuals with T2DM, inclusive of those with severe coronary artery calcification. Incorporating lesion-specific FAI with the CACS provided incremental predictive power for MACE in the T2DM patients.

Publisher

Research Square Platform LLC

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