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Abstract：
Background and Objectives: The modified Duke index derived from coronary computed tomography angiography (CCTA) was designed to predict cardiovascular outcomes based on the severity of coronary stenosis. However, it does not take into consideration the presence or severity of peri-coronary inflammation. The peri-coronary fat attenuation index (FAI) is a novel imaging marker determined by CCTA which reflects the degree of inflammation in the coronary tree in patients with coronary artery disease. To assess the association between the modified Duke index assessed by CCTA, cardiovascular risk factors, and peri-coronary inflammation in the coronary arteries of patients with coronary artery disease. Materials and Methods: One hundred seventy-two patients who underwent CCTA for typical angina were assigned into two groups based on the modified Duke index: group 1-patients with low index, ≤3 (n = 107), and group 2-patients with high index, >3 (n = 65). Demographic, clinical, and CCTA data were collected for all patients, and FAI analysis of coronary inflammation was performed. Results: Patients with increased values of the modified Duke index were significantly older compared to those with a low index (61.83 ± 9.89 vs. 64.78 ± 8.9; p = 0.002). No differences were found between the two groups in terms of gender distribution, hypertension, hypercholesterolemia, or smoking history (all p > 0.5). The FAI score was significantly higher in patients from group 2, who presented a significantly higher score of inflammation compared to the patients in group 1, especially at the level of the right coronary artery (FAI score, 20.85 ± 15.80 vs. 14.61 ± 16.66; p = 0.01 for the right coronary artery, 13.85 ± 8.04 vs. 10.91 ± 6.5; p = 0.01 for the circumflex artery, 13.26 ± 10.18 vs. 11.37 ± 8.84; p = 0.2 for the left anterior descending artery). CaRi-Heart® analysis identified a significantly higher risk of future events among patients with a high modified Duke index (34.84% ± 25.86% vs. 16.87% ± 15.80%; p < 0.0001). ROC analysis identified a cut-off value of 12.1% of the CaRi-Heart® risk score for predicting a high severity of coronary lesions, with an AUC of 0.69. Conclusions: The CT-derived modified Duke index correlates well with local perilesional inflammation as assessed using the FAI score at different levels of the coronary circulation.
摘要：
背景和目的：改良的Duke指数来源于冠状动脉CT血管造影（CCTA），旨在根据冠状动脉狭窄的严重程度预测心血管预后。然而,它没有考虑冠状动脉周围炎症的存在或严重程度.冠状动脉周围脂肪衰减指数（FAI）是CCTA确定的一种新型成像标记，可反映冠心病患者冠状动脉树的炎症程度。为了评估CCTA评估的修改后的杜克指数之间的关联，心血管危险因素，和冠状动脉疾病患者冠状动脉的冠状动脉周围炎症。材料和方法：根据改良的Duke指数将一百七十二例因典型心绞痛而接受CCTA的患者分为两组：低指数的第1组患者，≤3（n=107），和第2组患者高指数，>3（n=65）。人口统计,临床,收集所有患者的CCTA数据，并对冠状动脉炎症进行FAI分析。结果：与低指数的患者相比，改良Duke指数的值增加的患者年龄显着（61.83±9.89vs.64.78±8.9；p=0.002）。两组在性别分布方面没有发现差异，高血压,高胆固醇血症,或吸烟史（所有p>0.5）。与第1组患者相比，第2组患者的FAI评分明显更高，尤其是在右冠状动脉水平（FAI评分，20.85±15.80vs.14.61±16.66；右冠状动脉p=0.01，13.85±8.04vs.10.91±6.5；回旋支动脉p=0.01，13.26±10.18vs.11.37±8.84；左前降支的p=0.2）。CaRi-Heart®分析发现，在改良Duke指数较高的患者中，未来事件的风险明显更高（34.84％±25.86％与16.87%±15.80%；p<0.0001）。ROC分析确定CaRi-Heart®风险评分的临界值为12.1%，用于预测冠状动脉病变的严重程度。AUC为0.69。结论：CT衍生的改良Duke指数与使用FAI评分在不同水平的冠状动脉循环评估的局部病灶周围炎症密切相关。
