Prognostic efficacy of peri-coronary adipose tissue volume and computed tomography derived fractional flow reserve alone and in combination on outcome of patients with chronic coronary syndrome

Coronary computed tomography angiography (CCTA) is a helpful tool in diagnosing coronary artery disease (CAD). Noninvasive imaging markers like peri-coronary adipose tissue volume (PCATV) and Computed Tomography Derived Fractional Flow Reserve (FFRCT) have attracted significant attention due to their prognostic potential.

To investigate the prognostic value of deep-learning based FFRCT (DL-FFRCT) and PCATV alone and in combination for outcome of patients with chronic coronary syndromes (CCS).

A retrospective pooled analysis of data from 268 CCS patients who underwent CCTA between January 2015 and March 2021 was performed. PCATV and DL-FFRCT were calculated. The individual and combined predicting efficacy of PCATV and DL-FFRCT for outcome was assessed in these patients. The mean follow-up time was 32 months. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) encompassed all-cause mortality, non-fatal myocardial infarction, stroke and cardiovascular hospitalization.

Based on the optimal cut-off value of PCATV, patients (mean age, 64.41±11.81 years, 63.81% male) were categorized into low (<7.03 cm³, n=195) and high (≥7.03 cm³, n=73) PCATV groups. The independent risk factors for high PCATV included age(OR:1.03; 95% CI:1.00,1.06; P=0.03), DL-FFRCT≤0.8 (OR:2.92; 95% CI;1.51,5.64; P=0.001), while the independent risk factors for low DL-FFRCT included PCATV≥7.03 cm³(OR:2.80; 95% CI:1.40,5.61; P=0.004) and total calcification score (TCS) (OR:1.002; 95% CI:1.001,1.002; P<0.001),among others. PCATV was a superior predictor for MACCE as compared to DL-FFRCT (AUC: 0.89 vs. 0.76; P<0.001). Combining PCATV with DL-FFRCT further increased the AUC to 0.91 (P<0.001 vs. P<0.001 vs. P<0.001). Kaplan-Meier analysis further underscored the negative impacts of elevated PCATV and reduced DL-FFRCT on patient outcomes.

PCATV is a novel and superior outcome predictor compared to DL-FFRCT in CCS patients. This study highlights the importance of combined assessment of PCATV and DL-FFRCT for the risk stratification in CCS patients.

Graphical Abstract