{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T08:35:20Z","timestamp":1785832520888,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T00:00:00Z","timestamp":1714953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Romanian Ministry of Education UEFISCDI","award":["PN-III-P4-ID-PCE-2020-2861"],"award-info":[{"award-number":["PN-III-P4-ID-PCE-2020-2861"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The modified Duke index derived from coronary computed tomography angiography (CCTA) was designed to predict cardiovascular outcomes based on the severity of coronary stenosis. However, it does not take into consideration the presence or severity of peri-coronary inflammation. The peri-coronary fat attenuation index (FAI) is a novel imaging marker determined by CCTA which reflects the degree of inflammation in the coronary tree in patients with coronary artery disease. To assess the association between the modified Duke index assessed by CCTA, cardiovascular risk factors, and peri-coronary inflammation in the coronary arteries of patients with coronary artery disease. Materials and\u00a0Methods: One hundred seventy-two patients who underwent CCTA for typical angina were assigned into two groups based on the modified Duke index: group 1\u2014patients with low index, \u22643 (n = 107), and group 2\u2014patients with high index, &gt;3 (n = 65). Demographic, clinical, and CCTA data were collected for all patients, and FAI analysis of coronary inflammation was performed. Results: Patients with increased values of the modified Duke index were significantly older compared to those with a low index (61.83 \u00b1 9.89 vs. 64.78 \u00b1 8.9; p = 0.002). No differences were found between the two groups in terms of gender distribution, hypertension, hypercholesterolemia, or smoking history (all p &gt; 0.5). The FAI score was significantly higher in patients from group 2, who presented a significantly higher score of inflammation compared to the patients in group 1, especially at the level of the right coronary artery (FAI score, 20.85 \u00b1 15.80 vs. 14.61 \u00b1 16.66; p = 0.01 for the right coronary artery, 13.85 \u00b1 8.04 vs. 10.91 \u00b1 6.5; p = 0.01 for the circumflex artery, 13.26 \u00b1 10.18 vs. 11.37 \u00b1 8.84; p = 0.2 for the left anterior descending artery). CaRi-Heart\u00ae analysis identified a significantly higher risk of future events among patients with a high modified Duke index (34.84% \u00b1 25.86% vs. 16.87% \u00b1 15.80%; p &lt; 0.0001). ROC analysis identified a cut-off value of 12.1% of the CaRi-Heart\u00ae risk score for predicting a high severity of coronary lesions, with an AUC of 0.69. Conclusions: The CT-derived modified Duke index correlates well with local perilesional inflammation as assessed using the FAI score at different levels of the coronary circulation.<\/jats:p>","DOI":"10.3390\/medicina60050765","type":"journal-article","created":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T15:09:36Z","timestamp":1715008176000},"page":"765","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Coronary Computed Tomography Angiography-Derived Modified Duke Index Is Associated with Peri-Coronary Fat Attenuation Index and Predicts Severity of Coronary Inflammation"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6793-9248","authenticated-orcid":false,"given":"Vasile-Bogdan","family":"Hala\u021biu","sequence":"first","affiliation":[{"name":"Physiology Department, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mures, 540139 T\u00e2rgu Mures, Romania"},{"name":"Cardiology Department, Emergency Clinical County Hospital of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imre","family":"Benedek","sequence":"additional","affiliation":[{"name":"Cardiology Department, Emergency Clinical County Hospital of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"},{"name":"Center of Advanced Research in Multimodality Cardiac Imaging, CardioMed Medical Center, 540124 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana-Patricia","family":"Rodean","sequence":"additional","affiliation":[{"name":"Cardiology Department, Emergency Clinical County Hospital of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"},{"name":"Center of Advanced Research in Multimodality Cardiac Imaging, CardioMed Medical Center, 540124 T\u00e2rgu Mure\u0219, Romania"},{"name":"Cardiology Department, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mures, 540139 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana-Oana","family":"Cojocariu","sequence":"additional","affiliation":[{"name":"Cardiology Department, Emergency Clinical County Hospital of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theofana","family":"Mih\u0103il\u0103","sequence":"additional","affiliation":[{"name":"Cardiology Department, Emergency Clinical County Hospital of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mures, 540139 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuel","family":"Bl\u00eendu","sequence":"additional","affiliation":[{"name":"Cardiology Department, Emergency Clinical County Hospital of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"},{"name":"Cardiology Department, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mures, 540139 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelian","family":"Ro\u0219ca","sequence":"additional","affiliation":[{"name":"Cardiology Department, Emergency Clinical County Hospital of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"},{"name":"Center of Advanced Research in Multimodality Cardiac Imaging, CardioMed Medical Center, 540124 T\u00e2rgu Mure\u0219, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mures, 540139 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0775-1566","authenticated-orcid":false,"given":"Botond-Barna","family":"M\u00e1ty\u00e1s","sequence":"additional","affiliation":[{"name":"Cardiology Department, Emergency Clinical County Hospital of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mures, 540139 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1105-930X","authenticated-orcid":false,"given":"Renata","family":"Gerculy","sequence":"additional","affiliation":[{"name":"Cardiology Department, Emergency Clinical County Hospital of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"},{"name":"Doctoral School of Medicine and Pharmacy, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mures, 540139 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7378-5756","authenticated-orcid":false,"given":"Florin","family":"Buicu","sequence":"additional","affiliation":[{"name":"Public Health and Health Management Department, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mures, 540139 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodora","family":"Benedek","sequence":"additional","affiliation":[{"name":"Cardiology Department, Emergency Clinical County Hospital of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"},{"name":"Cardiology Department, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mures, 540139 T\u00e2rgu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"DISCHARGE Trial Group, Maurovich-Horvat, P., Bosserdt, M., Kofoed, K.F., Rieckmann, N., Benedek, T., and Donnelly, P. (2022). CT or Invasive Coronary Angiography in Stable Chest Pain. N. Engl. J. Med., 386, 1591\u20131602.","DOI":"10.1056\/NEJMoa2200963"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"112","DOI":"10.31083\/j.rcm2404112","article-title":"New Concepts on the Pathophysiology of Acute Coronary Syndrome","volume":"24","author":"Yuan","year":"2023","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.2478\/jce-2023-0004","article-title":"Left Atrial Volume Quantified by MSCT Predicts Emergency Hospitalizations for AF and Arrhythmia Recurrence after Catheter Ablation","volume":"9","author":"Bordi","year":"2023","journal-title":"J. Cardiovasc. Emergencies"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.jacc.2007.03.067","article-title":"Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality","volume":"50","author":"Min","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Rodean, I.P., Laz\u0103r, L., Hala\u021biu, V.B., Biri\u0219, C., Benedek, I., and Benedek, T. (2021). Periodontal Disease Is Associated with Increased Vulnerability of Coronary Atheromatous Plaques in Patients Undergoing Coronary Computed Tomography Angiography-Results from the Atherodent Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10061290"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Chistiakov, D.A., Kashirskikh, D.A., Khotina, V.A., Grechko, A.V., and Orekhov, A.N. (2019). Immune-Inflammatory Responses in Atherosclerosis: The Role of Myeloid Cells. J. Clin. Med., 8.","DOI":"10.3390\/jcm8111798"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Rodean, I.P., Biris, C.I., Halatiu, V.B., Modiga, A., Lazar, L., Benedek, I., and Benedek, T. (2021). Is there a link between COVID-19 infection, periodontal disease and acute myocardial infarction?. Life, 11.","DOI":"10.3390\/life11101050"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"111","DOI":"10.2478\/jce-2023-0014","article-title":"Regional Differences in the Level of Inflammation Between the Right and Left Coronary Arteries\u2014A Coronary Computed Tomography Angiography Study of Epicardial Fat Attenuation Index in Four Scenarios of Cardiovascular Emergencies","volume":"9","author":"Benedek","year":"2023","journal-title":"J. Cardiovasc. Emergencies"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12903-020-01356-4","article-title":"The inflammation link between periodontal disease and coronary atherosclerosis in patients with acute coronary syndromes: Case-control study","volume":"21","author":"Wojtkowska","year":"2021","journal-title":"BMC Oral Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4936571","DOI":"10.1155\/2021\/4936571","article-title":"COVID-19 and Acute Coronary Syndromes: From Pathophysiology to Clinical Perspectives","volume":"2021","author":"Esposito","year":"2021","journal-title":"Oxid. Med. Cell Longev."},{"key":"ref_11","first-page":"2677","article-title":"Standardized measurement of coronary inflammation using cardiovascular computed tomography: Integration in clinical care as a prognostic medical device","volume":"117","author":"Oikonomou","year":"2021","journal-title":"Cardiovasc. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4865","DOI":"10.21037\/jtd-22-1536","article-title":"Pericoronary fat attenuation index is associated with plaque parameters and stenosis severity in patients with acute coronary syndrome: A cross-sectional study","volume":"14","author":"Zhang","year":"2022","journal-title":"J. Thorac. Dis."},{"key":"ref_13","first-page":"460","article-title":"Biomarkers of Vascular Inflammation for Cardiovascular Risk Prognostication: A Meta-Analysis","volume":"15","author":"Antonopoulos","year":"2022","journal-title":"JACC"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.jcct.2019.03.006","article-title":"State-of-the-art review article. Atherosclerosis affecting fat: What can we learn by imaging perivascular adipose tissue?","volume":"13","author":"Antoniades","year":"2019","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/j.clinthera.2023.09.019","article-title":"Enhancing Risk Stratification on Coronary Computed Tomography Angiography: The Role of Artificial Intelligence","volume":"45","author":"Jaltotage","year":"2023","journal-title":"Clin. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"489","DOI":"10.21037\/cdt.2016.11.06","article-title":"Plaque imaging with CT-a comprehensive review on coronary CT angiography-based risk assessment","volume":"7","author":"Szilveszter","year":"2017","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1161\/CIRCULATIONAHA.120.049755","article-title":"Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity","volume":"144","author":"Reynolds","year":"2021","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1186\/s12872-021-02286-x","article-title":"Prognostic value of CAD-RADS classification by coronary CTA in patients with suspected CAD","volume":"21","author":"Huang","year":"2021","journal-title":"BMC Cardiovasc. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"6048","DOI":"10.21037\/qims-23-147","article-title":"Is there an association between coronary artery inflammation and coronary atherosclerotic burden?","volume":"13","author":"Jing","year":"2023","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/j.jacc.2020.06.052","article-title":"Long-Term Survival After Surgical or Percutaneous Revascularization in Patients With Diabetes and Multivessel Coronary Disease","volume":"76","author":"Tam","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Henein, M.Y., Vancheri, S., Longo, G., and Vancheri, F. (2022). The Role of Inflammation in Cardiovascular Disease. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms232112906"},{"key":"ref_22","first-page":"575","article-title":"Inflammation-based different association between anatomical severity of coronary artery disease and lung cancer","volume":"19","author":"Zhao","year":"2022","journal-title":"J. Geriatr. Cardiol."},{"key":"ref_23","first-page":"85","article-title":"Investigating the relationship between the severity of coronary artery disease and inflammatory factors of MHR, PHR, NHR, and IL-25","volume":"35","author":"Manoochehri","year":"2021","journal-title":"Med. J. Islam. Repub. Iran"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e153","DOI":"10.1161\/CIR.0000000000001052","article-title":"Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association","volume":"145","author":"Tsao","year":"2022","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","article-title":"2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes","volume":"41","author":"Knuuti","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1016\/j.jacc.2009.09.009","article-title":"Transatlantic Network on Atherothrombosis. Inflammation in atherosclerosis: From pathophysiology to practice","volume":"54","author":"Libby","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Sorriento, D., and Iaccarino, G. (2019). Inflammation and Cardiovascular Diseases: The Most Recent Findings. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20163879"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1175174","DOI":"10.3389\/fcvm.2023.1175174","article-title":"Inflammation biomarkers are associated with the incidence of cardiovascular disease: A meta-analysis","volume":"10","author":"Liu","year":"2023","journal-title":"Front. Cardiovasc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"101619","DOI":"10.1016\/j.eclinm.2022.101619","article-title":"Long-term cardiovascular outcomes in COVID-19 survivors among non-vacinated population: A retrospective cohort study from the TriNetX US collaborative networks","volume":"53","author":"Wang","year":"2022","journal-title":"EClinicalMedicine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1038\/s41586-021-03392-8","article-title":"The changing landscape of atherosclerosis","volume":"592","author":"Libby","year":"2021","journal-title":"Nature"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3827","DOI":"10.1093\/eurheartj\/ehad484","article-title":"Perivascular adipose tissue as a source of therapeutic targets and clinical biomarkers","volume":"44","author":"Antoniades","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Yan, H., Zhao, N., Geng, W., Hou, Z., Gao, Y., and Lu, B. (2022). The Perivascular Fat Attenuation Index Improves the Diagnostic Performance for Functional Coronary Stenosis. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9050128"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e022879","DOI":"10.1161\/JAHA.121.022879","article-title":"Pericoronary Fat Attenuation Index Is Associated with Vulnerable Plaque Components and Local Immune-Inflammatory Activation in Patients With Non-ST Elevation Acute Coronary Syndrome","volume":"11","author":"Sun","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e200563","DOI":"10.1148\/ryct.2021200563","article-title":"Assessing Cardiovascular Risk by Using the Fat Attenuation Index in Coronary CT Angiography","volume":"3","author":"Oikonomou","year":"2021","journal-title":"Radiology. Cardiothorac. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12889-023-17504-8","article-title":"Prevalence and trend of multiple coronary artery disease risk factors and their 5-year incidence rate among adult population of Kerman: Results from KERCADR study","volume":"24","author":"Najafipour","year":"2024","journal-title":"BMC Public Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"576","DOI":"10.31925\/farmacia.2021.3.21","article-title":"Statins and the risk for coronary in-stent restenosis in diabetic patients","volume":"69","author":"Ionescu","year":"2021","journal-title":"Farmacia"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/5\/765\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:40:17Z","timestamp":1760107217000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/5\/765"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,6]]},"references-count":36,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["medicina60050765"],"URL":"https:\/\/doi.org\/10.3390\/medicina60050765","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,6]]}}}