冠状动脉周围脂肪衰减指数最新研究进展
Recent Advances in Coronary Perivascular Fat Attenuation Index
DOI: 10.12677/md.2025.152024, PDF,   
作者: 朱清坦：济宁医学院临床医学院，山东 济宁；济宁市第一人民医院放射科，山东 济宁；王 敏*：济宁市第一人民医院放射科，山东 济宁
关键词: 冠状动脉周围脂肪组织；冠状动脉计算机断层扫描血管造影；脂肪衰减指数；冠状动脉疾病；Pericoronary Adipose Tissue； Coronary Computed Tomography Angiography； Fat Attenuation Index； Coronary Artery Disease
摘要: 冠状动脉周围脂肪衰减指数(Fat Attenuation Index, FAI)是一种从冠状动脉计算机断层扫描血管造影(coronary computed tomography angiography, CCTA)中提取的新型生物标志物，用于通过识别冠状动脉周围脂肪组织(pericoronary adipose tissue, PCAT)的衰减梯度来检测血管炎症，近年来在心血管医学领域引起了广泛的关注。FAI通过分析冠状动脉周围脂肪组织的衰减特征，为心血管疾病的筛查和风险评估提供了新的思路。本文将对FAI的定义、测量方法以及其在临床中的潜在价值进行综述，重点分析近年来相关研究的最新进展及其在心血管疾病的相关性及对疾病预后的预测价值。最后，本文旨在为未来的研究提供方向和建议，推动PFAI在心血管疾病管理中的应用。
Abstract: The coronary perivascular fat attenuation index (FAI), a novel biomarker derived from coronary computed tomography angiography (CCTA), has garnered significant attention in cardiovascular medicine in recent years. FAI detects vascular inflammation by identifying attenuation gradients in pericoronary adipose tissue (PCAT), offering innovative insights for cardiovascular disease screening and risk stratification. This review delineates the definition, measurement methodologies, and clinical implications of FAI, with a focus on recent advancements in its correlation with coronary artery disease (CAD) and its prognostic value. Furthermore, we discuss emerging applications of FAI in clinical practice and highlight future research directions to optimize its integration into cardiovascular disease management.
文章引用：朱清坦, 王敏. 冠状动脉周围脂肪衰减指数最新研究进展[J]. 医学诊断, 2025, 15(2): 178-184. https://doi.org/10.12677/md.2025.152024

参考文献

[1] 国家心血管病中心, 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2023概要[J]. 中国循环杂志, 2024, 39(7): 625-660.
[2] The DISCHARGE Trial Group (2022) CT or Invasive Coronary Angiography in Stable Chest Pain. New England Journal of Medicine, 386, 1591-1602. [Google Scholar] [CrossRef] [PubMed]
[3] Lee, S., Sung, J.M., Andreini, D., Al-Mallah, M.H., Budoff, M.J., Cademartiri, F., et al. (2020) Differences in Progression to Obstructive Lesions per High-Risk Plaque Features and Plaque Volumes with CCTA. JACC: Cardiovascular Imaging, 13, 1409-1417. [Google Scholar] [CrossRef] [PubMed]
[4] Douglas, P.S., Hoffmann, U., Patel, M.R., Mark, D.B., Al-Khalidi, H.R., Cavanaugh, B., et al. (2015) Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease. New England Journal of Medicine, 372, 1291-1300. [Google Scholar] [CrossRef] [PubMed]
[5] Oikonomou, E.K., Marwan, M., Desai, M.Y., Mancio, J., Alashi, A., Hutt Centeno, E., et al. (2018) Non-Invasive Detection of Coronary Inflammation Using Computed Tomography and Prediction of Residual Cardiovascular Risk (the CRISP CT Study): A Post-Hoc Analysis of Prospective Outcome Data. The Lancet, 392, 929-939. [Google Scholar] [CrossRef] [PubMed]
[6] Ross, R. (1999) Atherosclerosis—An Inflammatory Disease. New England Journal of Medicine, 340, 115-126. [Google Scholar] [CrossRef] [PubMed]
[7] Mazurek, T., Zhang, L., Zalewski, A., Mannion, J.D., Diehl, J.T., Arafat, H., et al. (2003) Human Epicardial Adipose Tissue Is a Source of Inflammatory Mediators. Circulation, 108, 2460-2466. [Google Scholar] [CrossRef] [PubMed]
[8] Mancio, J., Oikonomou, E.K. and Antoniades, C. (2018) Perivascular Adipose Tissue and Coronary Atherosclerosis. Heart, 104, 1654-1662. [Google Scholar] [CrossRef] [PubMed]
[9] Antoniades, C., Antonopoulos, A.S. and Deanfield, J. (2019) Imaging Residual Inflammatory Cardiovascular Risk. European Heart Journal, 41, 748-758. [Google Scholar] [CrossRef] [PubMed]
[10] Antoniades, C., Kotanidis, C.P. and Berman, D.S. (2019) State-of-the-Art Review Article. Atherosclerosis Affecting Fat: What Can We Learn by Imaging Perivascular Adipose Tissue? Journal of Cardiovascular Computed Tomography, 13, 288-296. [Google Scholar] [CrossRef] [PubMed]
[11] Antonopoulos, A.S., Sanna, F., Sabharwal, N., Thomas, S., Oikonomou, E.K., Herdman, L., et al. (2017) Detecting Human Coronary Inflammation by Imaging Perivascular Fat. Science Translational Medicine, 9, Article No. 2658. [Google Scholar] [CrossRef] [PubMed]
[12] Sagris, M., Antonopoulos, A.S., Simantiris, S., Oikonomou, E., Siasos, G., Tsioufs, K., et al. (2022) Pericoronary Fat Attenuation Index—A New Imaging Biomarker and Its Diagnostic and Prognostic Utility: A Systematic Review and Meta-Analysis. European Heart Journal—Cardiovascular Imaging, 23, e526-e536.
[13] Lin, A., Nerlekar, N., Yuvaraj, J., et al. (2021) Pericoronary Adipose Tissue Computed Tomography Attenuation Distinguishes Different Stages of Coronary Artery Disease: A Cross-Sectional Study. European Heart Journal-Cardiovascular Imaging, 22, 298-306. [Google Scholar] [CrossRef] [PubMed]
[14] Yu, Y.N., Liu, Y.Q. and Chen, Y.D. (2021) Research Progress of Perivascular Adipose Tissue and Vascular Inflammation in Coronary Heart Disease. Chin J Cardiovasc Med, 26, 294-298.
[15] Ma, R., van Assen, M., Ties, D., Pelgrim, G.J., van Dijk, R., Sidorenkov, G., et al. (2021) Focal Pericoronary Adipose Tissue Attenuation Is Related to Plaque Presence, Plaque Type, and Stenosis Severity in Coronary CTA. European Radiology, 31, 7251-7261. [Google Scholar] [CrossRef] [PubMed]
[16] Oikonomou, E.K., Siddique, M. and Antoniades, C. (2020) Artificial Intelligence in Medical Imaging: A Radiomic Guide to Precision Phenotyping of Cardiovascular Disease. Cardiovascular Research, 116, 2040-2054. [Google Scholar] [CrossRef] [PubMed]
[17] Etter, D., Warnock, G., Koszarski, F., Niemann, T., Mikail, N., Bengs, S., et al. (2022) Towards Universal Comparability of Pericoronary Adipose Tissue Attenuation: A Coronary Computed Tomography Angiography Phantom Study. European Radiology, 33, 2324-2330. [Google Scholar] [CrossRef] [PubMed]
[18] van Rosendael, S.E., Kuneman, J.H., van den Hoogen, I.J., Kitslaar, P.H., van Rosendael, A.R., van der Bijl, P., et al. (2022) Vessel and Sex Differences in Pericoronary Adipose Tissue Attenuation Obtained with Coronary CT in Individuals without Coronary Atherosclerosis. The International Journal of Cardiovascular Imaging, 38, 2781-2789. [Google Scholar] [CrossRef] [PubMed]
[19] Goeller, M., Achenbach, S., Cadet, S., Kwan, A.C., Commandeur, F., Slomka, P.J., et al. (2018) Pericoronary Adipose Tissue Computed Tomography Attenuation and High-Risk Plaque Characteristics in Acute Coronary Syndrome Compared with Stable Coronary Artery Disease. JAMA Cardiology, 3, Article No. 858. [Google Scholar] [CrossRef] [PubMed]
[20] Wang, K., Balmforth, C., Meah, M.N., Daghem, M., Moss, A.J., Tzolos, E., et al. (2024) Coronary Atherosclerotic Plaque Activity and Risk of Myocardial Infarction. Journal of the American College of Cardiology, 83, 2135-2144. [Google Scholar] [CrossRef] [PubMed]
[21] Maurovich-Horvat, P., Ferencik, M., Voros, S., Merkely, B. and Hoffmann, U. (2014) Comprehensive Plaque Assessment by Coronary CT Angiography. Nature Reviews Cardiology, 11, 390-402. [Google Scholar] [CrossRef] [PubMed]
[22] Chan, K., Wahome, E., Tsiachristas, A., Antonopoulos, A.S., Patel, P., Lyasheva, M., et al. (2024) Inflammatory Risk and Cardiovascular Events in Patients without Obstructive Coronary Artery Disease: The ORFAN Multicentre, Longitudinal Cohort Study. The Lancet, 403, 2606-2618. [Google Scholar] [CrossRef] [PubMed]
[23] Zhang, W., Li, P., Chen, X., He, L., Zhang, Q. and Yu, J. (2023) The Association of Coronary Fat Attenuation Index Quantified by Automated Software on Coronary Computed Tomography Angiography with Adverse Events in Patients with Less than Moderate Coronary Artery Stenosis. Diagnostics, 13, Article No. 2136. [Google Scholar] [CrossRef] [PubMed]
[24] Nogic, J., Kim, J., Layland, J., Cheng, K., Dey, D., Wong, D.T., et al. (2023) Peri-Coronary Adipose Tissue Is a Predictor of Stent Failure in Patients Undergoing Percutaneous Coronary Intervention. Cardiovascular Revascularization Medicine, 53, 61-66. [Google Scholar] [CrossRef] [PubMed]
[25] Lu, Z., Yin, W., Schoepf, U.J., Abrol, S., Ma, J., Zhao, L., et al. (2024) Prediction Value of Pericoronary Fat Attenuation Index for Coronary In-Stent Restenosis. European Radiology, 34, 4950-4959. [Google Scholar] [CrossRef] [PubMed]
[26] Elnabawi, Y.A., Oikonomou, E.K., Dey, A.K., Mancio, J., Rodante, J.A., Aksentijevich, M., et al. (2019) Association of Biologic Therapy with Coronary Inflammation in Patients with Psoriasis as Assessed by Perivascular Fat Attenuation Index. JAMA Cardiology, 4, Article No. 885. [Google Scholar] [CrossRef] [PubMed]
[27] Ichikawa, K., Miyoshi, T., Osawa, K., Nakashima, M., Miki, T., Nishihara, T., et al. (2022) High Pericoronary Adipose Tissue Attenuation on Computed Tomography Angiography Predicts Cardiovascular Events in Patients with Type 2 Diabetes Mellitus: Post-Hoc Analysis from a Prospective Cohort Study. Cardiovascular Diabetology, 21, Article No. 44. [Google Scholar] [CrossRef] [PubMed]
[28] Dai, X., Yu, L., Lu, Z., Shen, C., Tao, X. and Zhang, J. (2020) Serial Change of Perivascular Fat Attenuation Index after Statin Treatment: Insights from a Coronary CT Angiography Follow-Up Study. International Journal of Cardiology, 319, 144-149. [Google Scholar] [CrossRef] [PubMed]
[29] Xu, P., Liu, T., Zhou, F., Chen, Q., Rowe, J., Tesche, C., et al. (2024) Artificial Intelligence in Coronary Computed Tomography Angiography. Medicine Plus, 1, Article ID: 100001. [Google Scholar] [CrossRef] 
[30] 肖华伟, 王相权, 杨盼峰, 等. 深度学习图像重建算法对冠状动脉周围脂肪组织评估的影响[J]. 中华放射学杂志, 2025, 59(1): 91-94.
[31] Hoshino, M., Yang, S., Sugiyama, T., Zhang, J., Kanaji, Y., Yamaguchi, M., et al. (2020) Peri-Coronary Inflammation Is Associated with Findings on Coronary Computed Tomography Angiography and Fractional Flow Reserve. Journal of Cardiovascular Computed Tomography, 14, 483-489. [Google Scholar] [CrossRef] [PubMed]
[32] Yu, M., Dai, X., Deng, J., Lu, Z., Shen, C. and Zhang, J. (2019) Diagnostic Performance of Perivascular Fat Attenuation Index to Predict Hemodynamic Significance of Coronary Stenosis: A Preliminary Coronary Computed Tomography Angiography Study. European Radiology, 30, 673-681. [Google Scholar] [CrossRef] [PubMed]
[33] Wen, D., Li, J., Ren, J., Zhao, H., Li, J. and Zheng, M. (2021) Pericoronary Adipose Tissue CT Attenuation and Volume: Diagnostic Performance for Hemodynamically Significant Stenosis in Patients with Suspected Coronary Artery Disease. European Journal of Radiology, 140, Article ID: 109740. [Google Scholar] [CrossRef] [PubMed]
[34] Nayfeh, M., Ahmed, A.I., Alahdab, F., Al Rifai, M. and Al-Mallah, M. (2023) No Contrast? No Problem! Value in Assessing Pericoronary Fat in Non-Contrast Studies. Atherosclerosis, 370, 3-4. [Google Scholar] [CrossRef]