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Ma GP, Wu XJ, Jia CF. Prognostic value and limitations of the pericoronary fat attenuation index: A narrative review. World J Cardiol 2026; 18(11): 126179 [DOI: 10.4330/wjc.126179]
World J Cardiol. Nov 26, 2026; 18(11): 126179 Published online Nov 26, 2026. doi: 10.4330/wjc.126179
Prognostic value and limitations of the pericoronary fat attenuation index: A narrative review
Guo-Ping Ma, Xiang-Jie Wu, Chong-Fu Jia
Guo-Ping Ma, Xiang-Jie Wu, Chong-Fu Jia, Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Co-first authors: Guo-Ping Ma and Xiang-Jie Wu.
Author contributions: Ma GP and Wu XJ wrote the manuscript, edited and prepared all the necessary documents, contributed equally to this work and share first authorship, thus qualifying as the co-first authors of the paper; Ma GP, Wu XJ, and Jia CF contributed to the literature search; Jia CF provided overall guidance on the research direction and academic framework of the review; all authors have read and approved the final manuscript.
AI contribution statement: While the manuscript did not use any artificial intelligence tools for content creation, standard digital tools commonly available within word-processing applications may have been used to assist with minor grammar and spell-checking issues during the revision process.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Chong-Fu Jia, PhD, Professor, Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road, Dalian 116011, Liaoning Province, China. wzx1128@163.com
Received: July 28, 2026 Revised: September 14, 2026 Accepted: October 23, 2026 Published online: November 26, 2026 Processing time: 112 Days and 6.6 Hours
Abstract
The pericoronary fat attenuation index (FAI) is a non-invasive biomarker derived from coronary computed tomographic angiography (CCTA) that reflects coronary inflammation by quantifying perivascular adipose tissue attenuation, evaluating plaque stability, and predicting the risk of cardiovascular events. However, its clinical utility is limited by confounders such as age, sex, body mass index, scanner type, tube voltage, and reconstruction algorithms, which lead to inconsistencies in the predictive performance of baseline FAI. Unlike baseline FAI, dynamic changes in FAI based on serial CCTA are not only associated with changes in coronary inflammation but may also help mitigate inherent inter-individual differences, thereby better capturing inflammatory evolution. Therefore, dynamic assessment of FAI may mitigate several confounding limitations inherent to static baseline measurements, offering potential incremental prognostic value for risk stratification. Nevertheless, multicenter studies are still needed to standardize CCTA scanning protocols and FAI measurement methods, establish thresholds for changes in FAI to guide prognosis, and provide reliable evidence for the management of coronary artery disease. This narrative review summarizes FAI pathophysiology, measurement, and clinical value, with an emphasis on the advantages of dynamic FAI changes.
Core Tip: The pericoronary fat attenuation index (FAI) can reflect coronary inflammation by quantifying perivascular fat attenuation. Baseline FAI has shown potential in plaque assessment and major adverse cardiovascular events prediction. Still, its utility is limited by confounders such as age, sex, body mass index, tube voltage, and reconstruction algorithms, causing heterogeneous cutoffs (-76.3 HU to -67.4 HU). Dynamic changes in FAI derived from serial coronary computed tomographic angiography reflect temporal inflammatory activity and help account for baseline inter-individual variability, thereby providing enhanced insights into cardiovascular risk over single-timepoint FAI assessment.
