Abstract
BACKGROUND: Coronary artery disease poses a chronic threat to public health. Early identification of risk factors for the formation of atherosclerotic plaques in patients with myocardial bridges (MB) is important. This study aimed to investigate the correlation between perivascular fat attenuation index (FAI) and coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) with proximal atherosclerotic plaque formation in left anterior descending myocardial bridges (LAD-MB). METHODS: We retrospectively analyzed patients with LAD-MB who received coronary computed tomography angiography (CCTA) at least twice from January 2014 to December 2023. The study enrolled 135 patients with LAD-MB. Based on the development of proximal atherosclerotic plaques in LAD-MB during follow-up, patients were divided into two groups: those with plaque formation (n=90) and those without plaque formation (n=45). For each patient, we recorded and measured clinical risk factors, the anatomical parameters of LAD-MB, proximal perivascular FAI of LAD-MB, and the change in CT-FFR (delta-CT-FFR). Quantitative analysis was performed of the correlation between perivascular FAI and delta-CT-FFR and atherosclerotic plaque formation proximal to LAD-MB. RESULTS: After controlling for clinical risk factors, MB length (P=0.043) and perivascular FAI (P=0.001) were independently associated with proximal atherosclerotic plaque development in LAD-MB. The combined prediction model for MB length and perivascular FAI had an area under the curve (AUC) of 0.755 [95% confidence interval (CI): 0.665-0.845], resulting in a higher diagnostic efficacy than any other parameter alone. There was a correlation between delta-CT-FFR and the formation of atherosclerotic plaques proximal to the LAD-MB (P=0.039). Moreover, dynamic changes in the perivascular FAI proximal to the LAD-MB correlated with vulnerability to plaques proximal to the LAD-MB (P=0.016). CONCLUSIONS: MB length and perivascular FAI are independent predictors of the formation of atherosclerotic plaque proximal to the LAD-MB. Delta-CT-FFR shows a correlation with proximal atherosclerotic plaque formation in LAD-MB, but lacks independent predictive value.