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Background <p>To evaluate whether preoperative pericoronary fat attenuation index (FAI) measured by coronary computed tomography angiography (CCTA) predicts delayed extubation following lung transplantation.</p> Methods <p>This retrospective study analyzed 208 consecutive lung transplant recipients who underwent preoperative CCTA. FAI was quantified in proximal 40&#xa0;mm segments of all three coronary arteries using dedicated software. Delayed extubation was defined as mechanical ventilation &gt; 72&#xa0;h postoperatively. Optimal FAI thresholds were determined using ROC analysis. Multivariable logistic regression assessed independent associations.</p> Results <p>Delayed extubation occurred in 38 patients (18.3%). These patients demonstrated significantly higher FAI values in the right coronary artery (RCA) (−&#xa0;62.1 ± 11.4 vs −&#xa0;87.8 ± 11.7 HU, <i>P</i> &lt; 0.001) and the left anterior descending artery (LAD) (−&#xa0;64.5 ± 10.1 vs −&#xa0;85.9 ± 10.5 HU, <i>P</i> &lt; 0.001). Optimal thresholds were −&#xa0;72.5 HU for RCA-FAI and −&#xa0;71.5 HU for LAD-FAI. After adjusting for APACHE II score and other variables, RCA-FAI remained independently associated with delayed extubation (OR 1.29, 95%CI 1.08–1.53, <i>P</i> &lt; 0.01). A three-vessel high FAI model achieved superior discrimination (AUC: 0.86) compared to single-vessel (AUC: 0.66) or two-vessel models (AUC: 0.73). Decision curve analysis confirmed clinical utility across relevant probability thresholds.</p> Conclusions <p>Preoperative FAI independently predicts delayed extubation following lung transplantation. Multi-vessel FAI assessment provides exceptional discriminative performance, offering a novel imaging biomarker for enhanced preoperative risk stratification that could guide perioperative management strategies.</p>

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Pericoronary fat attenuation index as a novel predictor of delayed extubation following lung transplantation: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Shuangxiang Lin,
  • Xiaodan Feng,
  • Fei Zeng,
  • Peipei Gu,
  • Kexin Wang,
  • Jiaxing Wu,
  • Meijuan Lan,
  • Xinhong Wang

摘要

Background

To evaluate whether preoperative pericoronary fat attenuation index (FAI) measured by coronary computed tomography angiography (CCTA) predicts delayed extubation following lung transplantation.

Methods

This retrospective study analyzed 208 consecutive lung transplant recipients who underwent preoperative CCTA. FAI was quantified in proximal 40 mm segments of all three coronary arteries using dedicated software. Delayed extubation was defined as mechanical ventilation > 72 h postoperatively. Optimal FAI thresholds were determined using ROC analysis. Multivariable logistic regression assessed independent associations.

Results

Delayed extubation occurred in 38 patients (18.3%). These patients demonstrated significantly higher FAI values in the right coronary artery (RCA) (− 62.1 ± 11.4 vs − 87.8 ± 11.7 HU, P < 0.001) and the left anterior descending artery (LAD) (− 64.5 ± 10.1 vs − 85.9 ± 10.5 HU, P < 0.001). Optimal thresholds were − 72.5 HU for RCA-FAI and − 71.5 HU for LAD-FAI. After adjusting for APACHE II score and other variables, RCA-FAI remained independently associated with delayed extubation (OR 1.29, 95%CI 1.08–1.53, P < 0.01). A three-vessel high FAI model achieved superior discrimination (AUC: 0.86) compared to single-vessel (AUC: 0.66) or two-vessel models (AUC: 0.73). Decision curve analysis confirmed clinical utility across relevant probability thresholds.

Conclusions

Preoperative FAI independently predicts delayed extubation following lung transplantation. Multi-vessel FAI assessment provides exceptional discriminative performance, offering a novel imaging biomarker for enhanced preoperative risk stratification that could guide perioperative management strategies.