Imaging biomarker measures coronary inflammation from fatty tissue

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A novel imaging biomarker is able to detect inflammation of fatty tissue surrounding the coronary arteries using computed tomography.

Researchers also say the non-invasive approach can predict all-cause and cardiac mortality.

Developed by researchers at the Cleveland Clinic, University of Erlangen in Germany and University of Oxford in the United Kingdom, the imaging biomarker captures inflammation by mapping spatial changes of perivascular fat attenuation on coronary computed tomography angiography.

Their findings from the Cardiovascular Risk Prediction using Computed Tomography (CRISP-CT) study, based on data collected from patients who received coronary CT angiography at the Cleveland Clinic and in Germany, were presented last week at the European Society of Cardiology Congress in Munich.

“This is an exciting new technology which has the potential for providing a simple, non-invasive answer to detect patients at risk for future fatal heart attacks,” says Milind Desai, MD, a Cleveland Clinic cardiologist and co-first author of the study. “More importantly, it highlights the incredible value of cross-continent collaboration to validate the findings in different populations.”

The results from the study of the imaging biomarker—the perivascular fat attenuation index—were published online last week in the journal Lancet.

“The perivascular FAI enhances cardiac risk prediction and re-stratification over and above current state-of-the-art assessment in coronary CTA by providing a quantitative measure of coronary inflammation,” conclude the authors. “High perivascular FAI values are an indicator of increased cardiac mortality and, therefore, could guide early targeted primary prevention and intensive secondary prevention in patients.”

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“This new technology may prove transformative for primary and secondary prevention. For the first time we have a set of biomarkers, derived from a routine test that is already used in everyday clinical practice, that measures what we call the ‘residual cardiovascular risk’, currently missed by all risk scores and non-invasive tests,” said Charalambos Antoniades, MD, who led the study at the University of Oxford’s Division of Cardiovascular Medicine. “Knowing who is at increased risk for a heart attack could allow us to intervene early enough to prevent it. I expect these biomarkers to become an essential part of standard CT coronary angiography reporting in the coming years.”

At the same time, researchers noted that the ability of the perivascular FAI to predict clinical outcomes is unknown.

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