Correlation between the coronary computed tomography angiography-derived pericoronary fat attenuation index and coronary artery lesions in Kawasaki disease

Background: Kawasaki disease (KD), a type of acute systemic vasculitis that affects children, involves the coronary arteries and causes coronary artery lesions (CALs), including dilation, aneurysms, stenosis, and thrombosis. The pericoronary fat attenuation index (FAI), a novel biomarker of perivascular inflammation derived from coronary computed tomography angiography (CCTA), has been extensively validated in the context of adult coronary artery disease for stratifying plaque vulnerability and predicting future cardiac events. This study aimed to investigate the correlation between the FAI and the presence and severity of CALs in patients with KD.

Methods: We retrospectively analyzed the coronary computed tomography angiography (CTA) datasets of 71 patients with KD (40 with documented CALs and 31 without CALs) and 30 age- and sex-matched controls. Pericoronary FAI was measured around the proximal segments of all major coronary arteries. The global FAI values and their differences between groups were analyzed. The FAI values, clinical data, and coronary artery dimensions (Z-scores) were compared between groups. In statistical analyses, independent samples t-tests, Pearson or Spearman correlation coefficients, and multivariate logistic regression were applied to determine the independent association between FAI and CALs.

Results: Pericoronary FAI values were significantly higher in patients with KD and CALs than in those without CALs [−69.2±5.0 vs. −76.0±7.2 Hounsfield units (HU), P<0.001] and were higher in all patients with KD than in healthy controls (−72.1±6.9 vs. −77.6±7.5 HU, P<0.001). A significant positive correlation was observed between elevated FAI and the inflammation marker, peak erythrocyte sedimentation rate (ESR) (r=0.39; P<0.001), and severity of CALs, including the maximum coronary artery size (r=0.31; P<0.05) and Z-score (r=0.34; P<0.05). Multivariate analysis identified FAI as an independent factor associated with the presence of CALs [odds ratio (OR) =1.32; 95% confidence interval (CI): 1.15–1.51; P<0.001]. In predicting CALs in patients with KD, the FAI provided additional value [area under the curve (AUC) =0.935; 95% CI: 0.885–0.986] when combined with clinical parameters.

Conclusions: The pericoronary FAI is significantly elevated in patients with KD and CALs and correlates with the severity of coronary involvement. FAI derived from routine coronary CTA may serve as a novel, noninvasive imaging biomarker for quantifying pericoronary inflammation and stratifying risk in patients with KD.