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Researchers have developed a new technology based on analysis of computed tomography (CT) coronary angiograms that can flag patients at risk of deadly heart attacks before they occur. Heart attacks are usually caused by inflamed plaques in the coronary artery causing an abrupt blockage of blood getting to the heart.
The team at the University of Oxford has shown that the most dangerous plaques release chemical messengers which modify the surrounding fat. They have developed a technology that detects the inflamed plaques that are prone to cause heart attacks by analysing CT images of the fat surrounding the arteries.
Their new biomarker-the Fat Attenuation Index (FAI), has been tested, the study supported by the British Heart Foundation and the NIHR Oxford Biomedical Research Centre, involved 3,900 patients from Europe (Erlangen, Germany) and the United States (Cleveland Clinic), who were followed up for ten years after they had a CT coronary angiogram.
The FAI technology was found to predict fatal heart attacks many years before they happen, with a significantly superior predictive accuracy compared with other methods. People with abnormal FAI had up to nine times higher risk of having a fatal heart attack in the next five years. These patients would be the ideal candidates for aggressive medical therapy to prevent the attack.
The new technology may prove transformative for primary and secondary prevention. Knowing who is at increased risk for a heart attack could allow early intervention to prevent it. These biomarkers can become an essential part of standard CT coronary angiography.
The new technology has the potential for providing a simple, non-invasive answer to detect patients at risk for future fatal heart attacks. More importantly, it highlights the incredible value of cross-continent collaboration to validate the findings in different populations. Most heart scans are good at spotting blockages caused by large plaques, but not the smaller, high-risk plaques that are likely to rupture and cause a heart attack.