Pericoronary fat attenuation index on coronary CT angiography and cardiovascular risk in patients with coronary artery disease and chronic kidney disease

Xiaozhao Lu; Pan Wei; Shangyi Tang; Weitao Ye; Zuxian Huang; Ziyao Yuan; Huangtao Ruan; Haozhang Huang; Weipeng Zhang; Chenyang Wang; Yu Kang; Jing Hu; Zeliang Li; Jingru Deng; Yingying Li; Wanying Wu; Wai-Kit Ming; Chun-Ka Wong; Ning Tan; Shiqun Chen; Jin Liu; Jiyan Chen; Yong Liu

doi:10.1186/s12882-025-04549-7

Pericoronary fat attenuation index on coronary CT angiography and cardiovascular risk in patients with coronary artery disease and chronic kidney disease

Xiaozhao Lu (Co-first Author)
, Pan Wei (Co-first Author)
, Shangyi Tang (Co-first Author)
, Weitao Ye (Co-first Author)
, Zuxian Huang
, Ziyao Yuan
, Huangtao Ruan
, Haozhang Huang
, Weipeng Zhang
, Chenyang Wang
, Yu Kang
, Jing Hu
, Zeliang Li
, Jingru Deng
, Yingying Li
, Wanying Wu
, Wai-Kit Ming
, Chun-Ka Wong
, Ning Tan
, Shiqun Chen^*

Jin Liu^*, Jiyan Chen^*, Yong Liu^*

^*Corresponding author for this work

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

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Abstract

Background: The pericoronary fat attenuation index (pFAI), derived from coronary computed tomography angiography (CCTA), is an emerging marker of local inflammation of coronary arteries. Its prognostic significance in patients with coronary artery disease (CAD) and chronic kidney disease (CKD), which share common inflammatory pathways, remains uncertain. This study aimed to assess the associations between the pFAI and cardiovascular and mortality risk in patients with concurrent CAD and CKD.
Methods: Patients with both CAD and CKD who underwent CCTA within 1 year of invasive coronary angiography were included from Cardiorenal Improvement-Ⅱ. The pFAI was measured around the proximal 40 mm of the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). High pFAI values were determined from the median levels of LAD (-81.0 HU), LCX (-78.8 HU) and RCA (-79.4 HU). The primary outcome was major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal myocardial infarction and stroke, and the secondary outcomes were cardiovascular and all-cause mortality. Multivariate Cox proportional hazards regression analysis was used to investigate the associations between pFAI and MACEs and cardiovascular and all-cause mortality.
Results: A total of 444 patients (mean age 70.7 ± 9.6 years, 32% female) were included, and 90 (20.3%) cases of MACE, 68 (15.3%) cases of cardiovascular mortality, and 125 (28.2%) cases of all-cause mortality occurred, with a median follow-up of 4.57 years. For MACEs in patients with high pFAI levels compared with those with low pFAI levels, the multivariable adjusted HR was 1.65 (95% CI: 1.02–2.66; P = 0.042) for LAD, 2.06 (95% CI: 1.23–3.45; P = 0.006) for LCX, and 1.71 (95% CI: 1.07–2.74; P = 0.025) for RCA. For cardiovascular and all-cause mortality, similar significant associations were observed (all P < 0.05).
Conclusions: A high pFAI for each major coronary artery was independently associated with an increased risk of MACEs and cardiovascular and all-cause mortality in patients with CAD and CKD.
© The Author(s) 2025.

Original language	English
Article number	632
Journal	BMC Nephrology
Volume	26
Issue number	1
Online published	12 Nov 2025
DOIs	https://doi.org/10.1186/s12882-025-04549-7
Publication status	Published - Dec 2025

Funding

This study was funded by the Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention (No. Z022017016), Guangdong Medical Research Foundation (A2024065), Guangdong Basic and Applied Basic Research Foundation (2022A1515012126), National Natural Science Foundation of China (No.82270339 and No.82470531), the Noncommunicable Chronic Diseases-National Science and Technology Major Project (2024ZD0532700)and AstraZeneca Externally Sponsored Research Project (ESR-23-22118).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Keywords

Cardiovascular risk
Chronic kidney disease
Coronary artery disease
Coronary CT angiography
Mortality
Pericoronary fat attenuation index

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This full text is made available under CC-BY-NC-ND 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/

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Lu, X., Wei, P., Tang, S., Ye, W., Huang, Z., Yuan, Z., Ruan, H., Huang, H., Zhang, W., Wang, C., Kang, Y., Hu, J., Li, Z., Deng, J., Li, Y., Wu, W., Ming, W.-K., Wong, C.-K., Tan, N., ... Liu, Y. (2025). Pericoronary fat attenuation index on coronary CT angiography and cardiovascular risk in patients with coronary artery disease and chronic kidney disease. BMC Nephrology, 26(1), Article 632. https://doi.org/10.1186/s12882-025-04549-7

@article{cfadda48695b456c95a63f6fe2cb99ed,

title = "Pericoronary fat attenuation index on coronary CT angiography and cardiovascular risk in patients with coronary artery disease and chronic kidney disease",

abstract = "Background: The pericoronary fat attenuation index (pFAI), derived from coronary computed tomography angiography (CCTA), is an emerging marker of local inflammation of coronary arteries. Its prognostic significance in patients with coronary artery disease (CAD) and chronic kidney disease (CKD), which share common inflammatory pathways, remains uncertain. This study aimed to assess the associations between the pFAI and cardiovascular and mortality risk in patients with concurrent CAD and CKD. Methods: Patients with both CAD and CKD who underwent CCTA within 1 year of invasive coronary angiography were included from Cardiorenal Improvement-Ⅱ. The pFAI was measured around the proximal 40 mm of the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). High pFAI values were determined from the median levels of LAD (-81.0 HU), LCX (-78.8 HU) and RCA (-79.4 HU). The primary outcome was major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal myocardial infarction and stroke, and the secondary outcomes were cardiovascular and all-cause mortality. Multivariate Cox proportional hazards regression analysis was used to investigate the associations between pFAI and MACEs and cardiovascular and all-cause mortality. Results: A total of 444 patients (mean age 70.7 ± 9.6 years, 32\% female) were included, and 90 (20.3\%) cases of MACE, 68 (15.3\%) cases of cardiovascular mortality, and 125 (28.2\%) cases of all-cause mortality occurred, with a median follow-up of 4.57 years. For MACEs in patients with high pFAI levels compared with those with low pFAI levels, the multivariable adjusted HR was 1.65 (95\% CI: 1.02–2.66; P = 0.042) for LAD, 2.06 (95\% CI: 1.23–3.45; P = 0.006) for LCX, and 1.71 (95\% CI: 1.07–2.74; P = 0.025) for RCA. For cardiovascular and all-cause mortality, similar significant associations were observed (all P < 0.05). Conclusions: A high pFAI for each major coronary artery was independently associated with an increased risk of MACEs and cardiovascular and all-cause mortality in patients with CAD and CKD. {\textcopyright} The Author(s) 2025.",

keywords = "Cardiovascular risk, Chronic kidney disease, Coronary artery disease, Coronary CT angiography, Mortality, Pericoronary fat attenuation index",

author = "Xiaozhao Lu and Pan Wei and Shangyi Tang and Weitao Ye and Zuxian Huang and Ziyao Yuan and Huangtao Ruan and Haozhang Huang and Weipeng Zhang and Chenyang Wang and Yu Kang and Jing Hu and Zeliang Li and Jingru Deng and Yingying Li and Wanying Wu and Wai-Kit Ming and Chun-Ka Wong and Ning Tan and Shiqun Chen and Jin Liu and Jiyan Chen and Yong Liu",

year = "2025",

month = dec,

doi = "10.1186/s12882-025-04549-7",

language = "English",

volume = "26",

journal = "BMC Nephrology",

issn = "1471-2369",

publisher = "BioMed Central Ltd.",

number = "1",

}

Lu, X, Wei, P, Tang, S, Ye, W, Huang, Z, Yuan, Z, Ruan, H, Huang, H, Zhang, W, Wang, C, Kang, Y, Hu, J, Li, Z, Deng, J, Li, Y, Wu, W, Ming, W-K, Wong, C-K, Tan, N, Chen, S, Liu, J, Chen, J & Liu, Y 2025, 'Pericoronary fat attenuation index on coronary CT angiography and cardiovascular risk in patients with coronary artery disease and chronic kidney disease', BMC Nephrology, vol. 26, no. 1, 632. https://doi.org/10.1186/s12882-025-04549-7

Pericoronary fat attenuation index on coronary CT angiography and cardiovascular risk in patients with coronary artery disease and chronic kidney disease. / Lu, Xiaozhao (Co-first Author); Wei, Pan (Co-first Author); Tang, Shangyi (Co-first Author) et al.
In: BMC Nephrology, Vol. 26, No. 1, 632, 12.2025.

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

TY - JOUR

T1 - Pericoronary fat attenuation index on coronary CT angiography and cardiovascular risk in patients with coronary artery disease and chronic kidney disease

AU - Lu, Xiaozhao

AU - Wei, Pan

AU - Tang, Shangyi

AU - Ye, Weitao

AU - Huang, Zuxian

AU - Yuan, Ziyao

AU - Ruan, Huangtao

AU - Huang, Haozhang

AU - Zhang, Weipeng

AU - Wang, Chenyang

AU - Kang, Yu

AU - Hu, Jing

AU - Li, Zeliang

AU - Deng, Jingru

AU - Li, Yingying

AU - Wu, Wanying

AU - Ming, Wai-Kit

AU - Wong, Chun-Ka

AU - Tan, Ning

AU - Chen, Shiqun

AU - Liu, Jin

AU - Chen, Jiyan

AU - Liu, Yong

PY - 2025/12

Y1 - 2025/12

N2 - Background: The pericoronary fat attenuation index (pFAI), derived from coronary computed tomography angiography (CCTA), is an emerging marker of local inflammation of coronary arteries. Its prognostic significance in patients with coronary artery disease (CAD) and chronic kidney disease (CKD), which share common inflammatory pathways, remains uncertain. This study aimed to assess the associations between the pFAI and cardiovascular and mortality risk in patients with concurrent CAD and CKD. Methods: Patients with both CAD and CKD who underwent CCTA within 1 year of invasive coronary angiography were included from Cardiorenal Improvement-Ⅱ. The pFAI was measured around the proximal 40 mm of the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). High pFAI values were determined from the median levels of LAD (-81.0 HU), LCX (-78.8 HU) and RCA (-79.4 HU). The primary outcome was major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal myocardial infarction and stroke, and the secondary outcomes were cardiovascular and all-cause mortality. Multivariate Cox proportional hazards regression analysis was used to investigate the associations between pFAI and MACEs and cardiovascular and all-cause mortality. Results: A total of 444 patients (mean age 70.7 ± 9.6 years, 32% female) were included, and 90 (20.3%) cases of MACE, 68 (15.3%) cases of cardiovascular mortality, and 125 (28.2%) cases of all-cause mortality occurred, with a median follow-up of 4.57 years. For MACEs in patients with high pFAI levels compared with those with low pFAI levels, the multivariable adjusted HR was 1.65 (95% CI: 1.02–2.66; P = 0.042) for LAD, 2.06 (95% CI: 1.23–3.45; P = 0.006) for LCX, and 1.71 (95% CI: 1.07–2.74; P = 0.025) for RCA. For cardiovascular and all-cause mortality, similar significant associations were observed (all P < 0.05). Conclusions: A high pFAI for each major coronary artery was independently associated with an increased risk of MACEs and cardiovascular and all-cause mortality in patients with CAD and CKD. © The Author(s) 2025.

AB - Background: The pericoronary fat attenuation index (pFAI), derived from coronary computed tomography angiography (CCTA), is an emerging marker of local inflammation of coronary arteries. Its prognostic significance in patients with coronary artery disease (CAD) and chronic kidney disease (CKD), which share common inflammatory pathways, remains uncertain. This study aimed to assess the associations between the pFAI and cardiovascular and mortality risk in patients with concurrent CAD and CKD. Methods: Patients with both CAD and CKD who underwent CCTA within 1 year of invasive coronary angiography were included from Cardiorenal Improvement-Ⅱ. The pFAI was measured around the proximal 40 mm of the left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). High pFAI values were determined from the median levels of LAD (-81.0 HU), LCX (-78.8 HU) and RCA (-79.4 HU). The primary outcome was major adverse cardiovascular events (MACEs), including cardiovascular mortality, nonfatal myocardial infarction and stroke, and the secondary outcomes were cardiovascular and all-cause mortality. Multivariate Cox proportional hazards regression analysis was used to investigate the associations between pFAI and MACEs and cardiovascular and all-cause mortality. Results: A total of 444 patients (mean age 70.7 ± 9.6 years, 32% female) were included, and 90 (20.3%) cases of MACE, 68 (15.3%) cases of cardiovascular mortality, and 125 (28.2%) cases of all-cause mortality occurred, with a median follow-up of 4.57 years. For MACEs in patients with high pFAI levels compared with those with low pFAI levels, the multivariable adjusted HR was 1.65 (95% CI: 1.02–2.66; P = 0.042) for LAD, 2.06 (95% CI: 1.23–3.45; P = 0.006) for LCX, and 1.71 (95% CI: 1.07–2.74; P = 0.025) for RCA. For cardiovascular and all-cause mortality, similar significant associations were observed (all P < 0.05). Conclusions: A high pFAI for each major coronary artery was independently associated with an increased risk of MACEs and cardiovascular and all-cause mortality in patients with CAD and CKD. © The Author(s) 2025.

KW - Cardiovascular risk

KW - Chronic kidney disease

KW - Coronary artery disease

KW - Coronary CT angiography

KW - Mortality

KW - Pericoronary fat attenuation index

UR - https://www.scopus.com/pages/publications/105021546755

UR - https://www.scopus.com/record/pubmetrics.uri?eid=2-s2.0-105021546755&origin=recordpage

U2 - 10.1186/s12882-025-04549-7

DO - 10.1186/s12882-025-04549-7

M3 - RGC 21 - Publication in refereed journal

C2 - 41225370

SN - 1471-2369

VL - 26

JO - BMC Nephrology

JF - BMC Nephrology

IS - 1

M1 - 632

ER -

Pericoronary fat attenuation index on coronary CT angiography and cardiovascular risk in patients with coronary artery disease and chronic kidney disease

Abstract

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Research Keywords

Publisher's Copyright Statement

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