A new predictor of coronary artery disease in acute ischemic stroke or transient ischemic attack patients: pericarotid fat density

• Published in: European radiology Vol. 34; no. 3; pp. 1667 - 1676
• Main Authors: Lan, Yu, Shang, Jin, Ma, Yue, Zhen, Yanhua, Dang, Yuxue, Ren, Dongqing, Liu, Ting, Ju, Ronghui, Guo, Ning, Wang, Ximing, Hou, Yang
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2024; Springer Nature B.V
• Subjects: Adipose tissue; Adipose Tissue - diagnostic imaging; Angiography; Cardiovascular disease; Carotid arteries; Carotid artery; Carotid Stenosis - complications; Carotid Stenosis - diagnostic imaging; Computed Tomography; Computed Tomography Angiography - methods; Constriction, Pathologic; Coronary Angiography - methods; Coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Stenosis; Coronary vessels; Density; Diagnostic Radiology; Head and neck; Heart diseases; Humans; Imaging; Internal Medicine; Interventional Radiology; Ischemia; Ischemic Attack, Transient - complications; Ischemic Attack, Transient - diagnostic imaging; Ischemic Stroke; Medical imaging; Medicine; Medicine & Public Health; Neuroradiology; Performance enhancement; Performance prediction; Plaque, Atherosclerotic; Prediction models; Predictive Value of Tests; Radiology; Regression analysis; Risk assessment; Risk Factors; Stenosis; Stroke; Tomography; Transient ischemic attack; Ultrasound; Vein & artery diseases; Ischemic attack; Adipose tissue; Ischemic stroke; Angiography; Coronary artery disease
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-023-10046-y

Objectives The study aims to evaluate the incremental predictive value of pericarotid fat density (PFD) on head and neck computed tomography angiography (CTA) for the obstructive coronary artery disease (CAD) (≥ 50% stenosis) relative to a clinical risk model (Framingham risk score (FRS)) and the degree of carotid artery stenosis and plaque type in acute ischemic stroke (AIS) or transient ischemic attack (TIA) patients without a known history of CAD. Methods In a cohort of 134 consecutive stable patients diagnosed with AIS or TIA undergoing head and neck CTA between January 2010 and December 2021, pericarotid adipose tissue density (PFD) was quantified using a dedicated software. We collected demographic and clinical data, assessed the risk of CAD using the FRS, and analyzed coronary and carotid artery CTA images. Univariate and multivariate logistic regression analyses were performed to assess associations between FRS, PFD, CTA variables, and obstructive CAD risk. Four prediction models were established to evaluate the incremental predictive value of PFD relative to FRS, stenosis degree, and plaque types. Receiver operating characteristic (ROC) curves were generated, and the areas under the curves (AUC) were compared. Results Increasing FRS, stenosis degree, and PFD values were positively correlated with obstructive CAD (all p  < 0.05). In the predictive models for obstructive CAD, the model incorporating carotid stenosis exhibited superior predictive performance compared to FRS alone ( p  < 0.05). Moreover, the predictive model integrating PFD demonstrated enhanced performance and yielded the highest AUC of the receiver operator characteristic curve (AUC = 0.783), with sensitivity and specificity values of 86.89% and 65.75%, respectively. Conclusion CTA-derived PFD measurements offer supplementary predictive value for obstructive CAD beyond FRS and stenosis, thereby facilitating improved risk stratification of TIA or stroke patients without a history of CAD history. Clinical relevance statement CTA-derived PFD provides incremental predictive value for obstructive coronary artery disease in acute ischemic stroke or transient ischemic attack patients without CAD history, beyond Framingham risk score and carotid artery stenosis degree, improving risk stratification. Key Points • Pericarotid fat density is associated with obstructive coronary artery disease in acute ischemic stroke or transient ischemic attack patients. • Higher pericarotid fat density corresponds to an increased risk of obstructive coronary artery disease. • Estimation of pericarotid fat density using computed tomography angiography imparts additional predictive value for obstructive CAD in risk stratification of acute ischemic stroke or transient ischemic attack patients.