Pericoronary fat attenuation index and coronary inflammation

2019 Future Leader Fellowship

Years funded: 2020-2023

Coronary artery disease (CAD) is the largest single cause of death in Australia and acute coronary syndrome (ACS) is responsible for much of its mortality and morbidity burden. ACS is usually due to rupture of high risk (HRP), inflamed but non-obstructive atherosclerotic plaque. Despite optimal lipid lowering therapy, patients with residual inflammatory risk still develop recurrent ACS. There is therefore a need for a non-invasive modality that can detect vascular inflammation and assess plaque morphology. Pericoronary fat attenuation index (FAI) is a new computed-tomography- coronary-angiography (CCTA) derived novel imaging biomarker which captures coronary inflammation by mapping spatial changes of pericoronary fat attenuation.

The advancement of CCTA provides an accurate and reproducible imaging tool by which HRP can be detected, characterised and quantified non-invasively and serially over time. I am an interventional cardiologist who is an international expert in CCTA assessment of: 

1. plaque morphology
2. vascular inflammation and
3. functional significance of coronary artery stenosis.

I had recently demonstrated that plaque progression assessment on CCTA is comparable to intravascular ultrasound (IVUS). My research will assess: 

1. whether FAI and plaque morphology assessment can identify patients that will develop future AC
2. the impact of statin therapy on FAI in culprit and non-culprit vessels after myocardial infarction
3. impact of statin on inflamed plaques with mild stenosis and
4. whether colchicine can make HRPs more stable and less inflammatory. My research will help translate the advancement of plaque morphology and inflammation assessment on CCTA to 1) better risk stratify patients with (or at risk for) coronary artery disease 2) better treat patients with HRP who at risk of future ACS.