ESC 2018: Novel imaging biomarker can predict risk of cardiac mortality

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Milind Desai (Cleveland Clinic, Cleveland, USA) and colleagues have identified a novel imaging biomarker that has been found to be able to predict all-cause and cardiac mortality by measuring inflammation of fatty tissue surrounding the coronary arteries.

Desai et al developed the perivascular fat attenuation index (FAI) as an imaging biomarker to quantify inflammation-induced changes in perivascular fat. A press release reports that FAI captures coronary inflammation by mapping the changes in perivascular fat on coronary computed tomography (CT) angiography, enabling early detection of coronary inflammation.

The CRISP-CT (Cardiovascular risk prediction using CT) study collected data from the two cohorts of consecutive patients undergoing coronary CT angiography—1,872 patients in Germany from 2005 to 2009 (derivation cohort) and 2,040 patients at Cleveland Clinic from 2008 to 2016 (validation cohort). Median patient age in the cohorts was 62 and 53 years. In both cohorts, higher perivascular FAI values —indicating greater coronary inflammation—were associated with significantly higher rates of death from any cause and death from cardiac causes.

Desai states: “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. It highlights the incredible value of cross-continent collaboration to validate the findings in different populations.”

Charalambos Antoniades, who led the study at the University of Oxford’s Division of Cardiovascular Medicine (Oxford, UK), states: “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. 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.”

The research was presented as a late-breaking presentation at the 2018 European Society of Cardiology (ESC) Congress (25–29 August, Munich, August) and published in the Lancet.

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